Provider Demographics
NPI:1356604722
Name:LEE, SAMUEL YEH-CHANG (ATC, CSCS, LMT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:YEH-CHANG
Last Name:LEE
Suffix:
Gender:M
Credentials:ATC, CSCS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 ULUKOU ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4426
Mailing Address - Country:US
Mailing Address - Phone:808-554-1310
Mailing Address - Fax:
Practice Address - Street 1:2429 PALI HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1452
Practice Address - Country:US
Practice Address - Phone:808-564-0341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2255A2300X
HIMAT 9287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist