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NPI Code Detail

MEDICARE: DR. KYUNG AE LEE D.M.D.

MEDICARE: DR. KYUNG AE LEE D.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
11223G0001XGeneral Practice Dentistry5065NV

General Provider Information

NPI Number : 1700900156
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KYUNG AE LEE D.M.D.
Provider Business Mailing Address
First Line : 6464 RAVEN HALL ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-1301
Country : US
Telephone Number : 702-732-1293
Fax Number :
Provider Business Practice Location Address
First Line : 7310 SMOKE RANCH RD
Second Line : # F
City : LAS VEGAS
State : NV
Zip : 89128-0258
Country : US
Telephone Number : 702-254-7507
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/08/2007

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