Provider Demographics
NPI:1699187369
Name:LEE, KEVIN KEI YAN (LMT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:KEI YAN
Last Name:LEE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-801 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3164
Mailing Address - Country:US
Mailing Address - Phone:808-680-9123
Mailing Address - Fax:808-680-9889
Practice Address - Street 1:94-801 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3164
Practice Address - Country:US
Practice Address - Phone:808-680-9123
Practice Address - Fax:808-680-9889
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist