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General NPI Number Information
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NPI Number | 1659525244
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Entity Type | Individual
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Provider Name | KEVIN SUK JAE LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2008
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 2215 BURDETT AVE
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City | TROY
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State | NY
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Zip | 12180-2475
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Country | US
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Telephone | 518-525-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 103 SANDY PINES BLVD
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533-8214
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Country | US
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Telephone | 917-837-7747
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 243169
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License Number State | NY
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