Provider Demographics
NPI:1679731566
Name:LEE, JOHN CH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CH
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 N KING ST STE 321
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4559
Mailing Address - Country:US
Mailing Address - Phone:808-841-3644
Mailing Address - Fax:808-843-8108
Practice Address - Street 1:2153 N KING ST STE 321
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4559
Practice Address - Country:US
Practice Address - Phone:808-841-3644
Practice Address - Fax:808-841-3555
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7337174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05766101Medicaid