1376703629 NPI number — YURI HASEGAWA LEE BCBA

Table of content: YURI HASEGAWA LEE BCBA (NPI 1376703629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376703629 NPI number — YURI HASEGAWA LEE BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
YURI
Provider Middle Name:
HASEGAWA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HASEGAWA
Provider Other First Name:
YURI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376703629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1009 KAPIOLANI BLVD APT 2607
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-2168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-293-4466
Provider Business Mailing Address Fax Number:
808-888-7231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1009 KAPIOLANI BLVD APT 2607
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-293-4466
Provider Business Practice Location Address Fax Number:
808-888-7231
Provider Enumeration Date:
06/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)