MEDICARE: KEVIN LEE

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	171100000X	Acupuncturist	332	GA

General Provider Information

NPI Number	:	1558848952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN LEE

Provider Business Mailing Address
First Line	:	3775 VENTURE DR BLDG N
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5102
Country	:	US
Telephone Number	:	770-817-9608
Fax Number	:	770-817-9610

Provider Business Practice Location Address
First Line	:	3775 VENTURE DR BLDG N
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5102
Country	:	US
Telephone Number	:	770-817-9608
Fax Number	:	770-817-9610

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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Directions to “ KEVIN LEE ” Practice Location

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