MEDICARE: KONG WING LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	22966	OK

General Provider Information

NPI Number	:	1487613170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KONG WING LEE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3802
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73083-3802
Country	:	US
Telephone Number	:	405-528-3888
Fax Number	:	405-528-3885

Provider Business Practice Location Address
First Line	:	1119 NW 25TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5646
Country	:	US
Telephone Number	:	405-528-3888
Fax Number	:	405-528-3885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/02/2008

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Directions to “ KONG WING LEE M.D.” Practice Location

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