Healthcare Provider Details

I. General information

NPI: 1144366196
Provider Name (Legal Business Name): LEE R. CHOO-KANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD SUITE 382-A
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD SUITE 382-A
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6933
  • Fax: 314-251-6088
Mailing address:
  • Phone: 314-251-6933
  • Fax: 314-251-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number2001007181
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: