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General NPI Number Information
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NPI Number | 1285734285
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Entity Type | Individual
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Provider Name | BOHYUNG KEN LEE MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 7950 W JEFFERSON BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-4140
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Country | US
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Telephone | 260-435-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 COUNTRY CLUB DR E
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City | WARSAW
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State | IN
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Zip | 46580-5013
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Country | US
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Telephone | 574-269-1242
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01037341
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License Number State | IN
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