Provider Demographics
NPI:1306939475
Name:LEE, EUGENE MC (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:MC
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 1:321 N KUAKINI ST
Mailing Address - Street 2:305
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2360
Mailing Address - Country:US
Mailing Address - Phone:808-523-5688
Mailing Address - Fax:808-523-0030
Practice Address - Street 1:321 N KUAKINI ST
Practice Address - Street 2:305
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2360
Practice Address - Country:US
Practice Address - Phone:808-523-5688
Practice Address - Fax:808-523-0030
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9489208000000X, 207R00000X
HIHOSPITALIST MD9489208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HID209561OtherHMSA
HIMD948902OtherMDX HI
HI08011201Medicaid
HIH51718Medicare ID - Type Unspecified
HID209561OtherHMSA