Provider Demographics
NPI:1669442851
Name:BUENCONSEJO-LUM, LEE E (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:E
Last Name:BUENCONSEJO-LUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LEHUA ST
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-2036
Mailing Address - Country:US
Mailing Address - Phone:808-621-8411
Mailing Address - Fax:808-621-4117
Practice Address - Street 1:95-390 KUAHELANI AVE
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1192
Practice Address - Country:US
Practice Address - Phone:808-627-3200
Practice Address - Fax:808-623-7872
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB208286OtherHMSA
HI07923201Medicaid
HIB208286OtherHMSA
HI50122Medicare ID - Type Unspecified