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NPI Code Detail

MEDICARE: DR. KYONG JOON LEE MD

MEDICARE: DR. KYONG JOON 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1497693220
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYONG JOON LEE MD
Provider Business Mailing Address
First Line : 506 E SAN ANTONIO ST
Second Line :
City : VICTORIA
State : TX
Zip : 77901-6060
Country : US
Telephone Number : 361-575-7441
Fax Number :
Provider Business Practice Location Address
First Line : 506 E SAN ANTONIO ST
Second Line :
City : VICTORIA
State : TX
Zip : 77901-6060
Country : US
Telephone Number : 361-575-7441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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