Provider Demographics
NPI:1124240924
Name:LEE, SCOTT LAURENCE (LACU)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:LAURENCE
Last Name:LEE
Suffix:
Gender:M
Credentials:LACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 KEAWE ST., SUITE 5
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-969-6819
Mailing Address - Fax:
Practice Address - Street 1:159 KEAWE ST., SUITE 5
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6720
Practice Address - Country:US
Practice Address - Phone:808-969-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI272171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist