Healthcare Provider Details

I. General information

NPI: 1548214158
Provider Name (Legal Business Name): JOHN K LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 NE SAINT LUKE'S BLVD SUITE 240
KANSAS CITY MO
64086
US

IV. Provider business mailing address

901 E 104TH ST MAILSTOP 400S
KANSAS CITY MO
64131
US

V. Phone/Fax

Practice location:
  • Phone: 816-931-1883
  • Fax: 816-751-8635
Mailing address:
  • Phone: 816-502-7117
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2000157007
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0428702
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2000157007
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: