Healthcare Provider Details

I. General information

NPI: 1326061862
Provider Name (Legal Business Name): KI HYEONG LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date: 04/23/2026
Reactivation Date: 05/21/2026

III. Provider practice location address

4275 JOHNS CREEK PKWY STE C
SUWANEE GA
30024-9117
US

IV. Provider business mailing address

4275 JOHNS CREEK PKWY STE C
SUWANEE GA
30024-9117
US

V. Phone/Fax

Practice location:
  • Phone: 912-513-1041
  • Fax: 762-316-2051
Mailing address:
  • Phone: 912-513-1041
  • Fax: 762-316-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number50400
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number50400
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME110288
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35.088259
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: