MEDICARE: DR. WING MANN LEE DMD

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	1223G0001X	General Practice Dentistry	55084	CA
2	122300000X	Dentist	2011026139	MO

General Provider Information

NPI Number	:	1568613362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WING MANN LEE DMD

Provider Business Mailing Address
First Line	:	4320 WORNALL RD STE 446
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3235
Country	:	US
Telephone Number	:	816-376-0851
Fax Number	:

Provider Business Practice Location Address
First Line	:	4320 WORNALL RD STE 446
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-3235
Country	:	US
Telephone Number	:	816-376-0851
Fax Number	:

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

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	03/03/2020

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