Provider Demographics
NPI:1992322580
Name:LEE, JEONGAH
Entity type:Individual
Prefix:
First Name:JEONGAH
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST STE 250
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1876
Mailing Address - Country:US
Mailing Address - Phone:808-545-2800
Mailing Address - Fax:808-262-3744
Practice Address - Street 1:1585 KAPIOLANI BLVD STE 1800
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4500
Practice Address - Country:US
Practice Address - Phone:808-545-2800
Practice Address - Fax:808-262-3744
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI78619163WW0101X
HI3109363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory