MEDICARE: DR. KWANG J 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	207W00000X	Ophthalmology Physician	6811	NV

Other Identifiers

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

General Provider Information

NPI Number	:	1790724854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWANG J LEE M.D.

Provider Business Mailing Address
First Line	:	6980 SMOKE RANCH RD
Second Line	:	STE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8605
Country	:	US
Telephone Number	:	702-732-4500
Fax Number	:	702-818-1393

Provider Business Practice Location Address
First Line	:	6980 SMOKE RANCH RD
Second Line	:	STE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8605
Country	:	US
Telephone Number	:	702-732-4500
Fax Number	:	702-818-1393

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/10/2021

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Directions to “ DR. KWANG J LEE M.D.” Practice Location

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