1881744225 NPI number — BRYAN T LEE D.P.T.

Table of content: BRYAN T LEE D.P.T. (NPI 1881744225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881744225 NPI number — BRYAN T LEE D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
BRYAN
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881744225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
770 KAPIOLANI BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-596-9446
Provider Business Mailing Address Fax Number:
808-596-9160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 KAPIOLANI BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-596-9446
Provider Business Practice Location Address Fax Number:
808-596-9160
Provider Enumeration Date:
01/10/2007

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: 2251X0800X , with the licence number:  1925 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 209006700 . This is a "OWCP #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 200684033 . This is a "UHC MEDICARE COMPLETE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 201621 . This is a "HMA SUMMERLIN" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 49621702 . This is a "ALOHA CARE QUEST #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 49621701 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: J0224970 . This is a "HMSA BCBS#" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00J0224970 . This is a "HMSA QUEST #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 3953566 . This is a "UHA #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 200684033 . This is a "HMAA #" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: Z1654 . This is a "MDX INSURANCE CO" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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