Provider Demographics
NPI:1851481907
Name:LEE, MARK C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:46-056 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3755
Mailing Address - Country:US
Mailing Address - Phone:808-233-6200
Mailing Address - Fax:808-233-6255
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 221
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3755
Practice Address - Country:US
Practice Address - Phone:808-233-6200
Practice Address - Fax:808-233-6255
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GUMD-13494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57086301Medicaid
HI0000254771OtherHMSA
HI9545444OtherUHA
HI9545444OtherUHA
HI100748Medicare ID - Type Unspecified