MEDICARE: DR. KI NYOUNG LEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	D0023473	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	555625	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255498028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KI NYOUNG LEE MD

Provider Business Mailing Address
First Line	:	9806 SORREL AVE
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854
Country	:	US
Telephone Number	:	301-299-8160
Fax Number	:

Provider Business Practice Location Address
First Line	:	3947 FERRARA DRIVE
Second Line	:
City	:	WHEATON
State	:	MD
Zip	:	20906-4709
Country	:	US
Telephone Number	:	301-942-9004
Fax Number	:	301-942-9004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. KI NYOUNG LEE MD” Practice Location

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