Provider Demographics
NPI:1669103370
Name:LEE, INA B
Entity type:Individual
Prefix:
First Name:INA
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:INA
Other - Middle Name:B
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1188 BISHOP ST STE 1610
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3306
Mailing Address - Country:US
Mailing Address - Phone:808-699-4449
Mailing Address - Fax:
Practice Address - Street 1:1188 BISHOP ST STE 1610
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3306
Practice Address - Country:US
Practice Address - Phone:808-699-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15870225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist