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General NPI Number Information
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NPI Number | 1851661953
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Entity Type | Organization
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Legal Business Name | S. KWON LEE, MD, INC
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Dates
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Enumeration Date | 01/05/2012
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 7807 LAGUNA BLVD STE 480
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City | ELK GROVE
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State | CA
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Zip | 95758-7953
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Country | US
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Telephone | 916-242-8499
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Fax | 916-405-7440
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Provider Business Mailing Address
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Address Line | PO BOX 583211
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City | ELK GROVE
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State | CA
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Zip | 95758-0057
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Country | US
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Telephone | 916-242-8499
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Fax | 916-405-7440
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEUNG KWON LEE
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Credential | M.D.
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Telephone | 916-242-8499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | C54971
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License Number State | CA
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