Provider Demographics
NPI:1821688508
Name:ISLAND MEDICAL AND BEAUTY CLINIC LLC
Entity Type:Organization
Organization Name:ISLAND MEDICAL AND BEAUTY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-466-5222
Mailing Address - Street 1:3470 WAIALAE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2654
Mailing Address - Country:US
Mailing Address - Phone:808-888-3100
Mailing Address - Fax:833-673-0575
Practice Address - Street 1:3470 WAIALAE AVE STE 6
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2654
Practice Address - Country:US
Practice Address - Phone:808-888-3100
Practice Address - Fax:833-673-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty