Provider Demographics
NPI:1366508277
Name:LEE, BRADLEY KAIPOLEIMANU (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KAIPOLEIMANU
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 1:590 FARRINGTON HWY
Mailing Address - Street 2:UNIT 526A
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2034
Mailing Address - Country:US
Mailing Address - Phone:808-674-2930
Mailing Address - Fax:808-674-2950
Practice Address - Street 1:590 FARRINGTON HWY
Practice Address - Street 2:UNIT 526A
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2034
Practice Address - Country:US
Practice Address - Phone:808-674-2930
Practice Address - Fax:808-674-2950
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50100815Medicaid
HIH55657Medicare ID - Type Unspecified
HIH41265Medicare UPIN