Provider Demographics
NPI:1740402650
Name:EUGENE M.C. LEE, MD, APC
Entity Type:Organization
Organization Name:EUGENE M.C. LEE, MD, APC
Other - Org Name:EUGENE M.C. LEE, MD, A PROFESSIONAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:MC
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-523-5688
Mailing Address - Street 1:321 N KUAKINI ST STE 305
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2360
Mailing Address - Country:US
Mailing Address - Phone:808-523-5688
Mailing Address - Fax:808-523-0030
Practice Address - Street 1:321 N KUAKINI ST STE 305
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2360
Practice Address - Country:US
Practice Address - Phone:808-523-5688
Practice Address - Fax:808-523-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9489207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID209561OtherHMSA
HI08011201Medicaid
HIMD9489-02OtherMDX-HI
HIH51718Medicare ID - Type Unspecified
HIMD9489-02OtherMDX-HI