MEDICARE: DR. KI-HYEOK LEE M.D.

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	208D00000X	General Practice Physician	A49999	CA

General Provider Information

NPI Number	:	1548250731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KI-HYEOK LEE M.D.

Provider Business Mailing Address
First Line	:	15301 WARREN SHINGLE RD
Second Line	:
City	:	BEALE AFB
State	:	CA
Zip	:	95903-1905
Country	:	US
Telephone Number	:	530-634-2941
Fax Number	:	530-634-4763

Provider Business Practice Location Address
First Line	:	15301 WARREN SHINGLE RD
Second Line	:
City	:	BEALE AFB
State	:	CA
Zip	:	95903-1905
Country	:	US
Telephone Number	:	530-634-4730
Fax Number	:	530-634-4763

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	09/04/2025

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