Jin Song Lee, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2550 Issued in HI

Practice address

86-260 Farrington Hwy
Waianae, HI 96792-3128

Phone

(808) 697-3300

NPI assigned

Mar 22, 2020

Last updated

Jun 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Waimanalo Health CenterGroup PAC ID 8527029198, 27 clinicians

Waianae District Comprehensive Health and Hospital Board IncorporatedGroup PAC ID 9931008349, 162 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jin.lee.p1@direct.waimanalohealth.nextgenshare.com
• Direct secure messaging: jin.lee.p1@direct.wcchc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Waianae District Comprehensive Health and Hospital Board, Inc

  dba Waianae Coast Comprehensive Health Center

  • Family Medicine Physician
  • Waianae, HI
  • NPI 1275566424

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Waimanalo Health Center

  • Federally Qualified Health Center (FQHC)
  • Waimanalo, HI
  • NPI 1780738005
  Medicare reassignment Care Compare group NPD
• Waianae District Comprehensive Health and Hospital Board, Inc

  • Clinical Medical Laboratory
  • Waianae, HI
  • NPI 1083749279
  NPD
• Waianae District Comprehensive Health and Hospital Board, Incorporated

  dba Waianae Elementary School

  • Federally Qualified Health Center (FQHC)
  • Waianae, HI
  • NPI 1710709365
  NPD
• Unlv Medicine

  • Internal Medicine Physician
  • Las Vegas, NV
  • NPI 1407397235
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717891200000",
    "number": "1508492448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3014 W CHARLESTON BLVD STE 130",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891020083",
            "telephone_number": "702-671-5127",
            "fax_number": "702-671-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86-260 FARRINGTON HWY",
            "city": "WAIANAE",
            "state": "HI",
            "postal_code": "967923128",
            "telephone_number": "808-697-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3014 W Charleston Blvd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891020083",
            "country_code": "US",
            "telephone_number": "702-671-5127",
            "fax_number": "702-671-6440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "JIN",
        "middle_name": "SONG",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-22",
        "last_updated": "2024-06-09",
        "certification_date": "2024-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "HI",
            "license": "2550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shavone Marie Kawailani Lave, M.A.
• Cara Lawler, DMD
• Megan Monk Ledezma Vera, APRN
• Clarence E. Lee, D.D.S.
• Dominique Lee, PA-C
• Joanna Lee, DMD
• Malia-Susanne L Lee, MD
• Mona Liza P. Lee
• Leeward Drug, LTD (Waianae Drug)
• Lafaaua M. Lefotu

• Psychiatry Physician in Waianae, HI
• Providers in Waianae, HI by specialty
• Psychiatry Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.