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General NPI Number Information
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NPI Number | 1255498028
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Entity Type | Individual
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Provider Name | KI NYOUNG LEE MD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3947 FERRARA DRIVE
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City | WHEATON
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State | MD
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Zip | 20906-4709
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Country | US
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Telephone | 301-942-9004
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Fax | 301-942-9004
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Provider Business Mailing Address
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Address Line | 9806 SORREL AVE
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City | POTOMAC
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State | MD
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Zip | 20854
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Country | US
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Telephone | 301-299-8160
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | D0023473
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License Number State | MD
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