Provider Demographics
NPI:1447373865
Name:EVSLIN, LEE A (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:A
Last Name:EVSLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4-1558 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1856
Mailing Address - Country:US
Mailing Address - Phone:808-822-4844
Mailing Address - Fax:808-821-2922
Practice Address - Street 1:4-1558 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1856
Practice Address - Country:US
Practice Address - Phone:808-822-4844
Practice Address - Fax:808-821-2922
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI3507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC98425Medicare UPIN