MEDICARE: KOK SEAH LEE MD PC

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	207RG0100X	Gastroenterology Physician	0101024647	VA

General Provider Information

NPI Number	:	1689859993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOK SEAH LEE MD PC

Provider Business Mailing Address
First Line	:	2296 OPITZ BLVD STE 210
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3345
Country	:	US
Telephone Number	:	703-670-5317
Fax Number	:

Provider Business Practice Location Address
First Line	:	2296 OPITZ BLVD STE 210
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3345
Country	:	US
Telephone Number	:	703-670-5317
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. KOK-SEAH LEE
Credential	:	M.D.
Telephone Number	:	703-670-5317

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	09/10/2009

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