Provider Demographics
NPI:1245554138
Name:LEE, DAVID WING (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WING
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 KUPUOHI ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-2714
Mailing Address - Country:US
Mailing Address - Phone:808-727-2117
Mailing Address - Fax:808-793-2238
Practice Address - Street 1:40 KUPUOHI ST STE 204
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761
Practice Address - Country:US
Practice Address - Phone:808-727-2117
Practice Address - Fax:808-793-2238
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO-202213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI743270Medicaid
HIE11311OtherHI CONTROLLED SUBSTANCE
HIPO-202OtherMEDICAL LICENSE
12579715OtherCAQH
1PD0050805OtherPICA
1PD0050805OtherPICA
HIPO-202OtherMEDICAL LICENSE
1PD0050805OtherPICA