MEDICARE: KYOUNGAE LEE

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	163W00000X	Registered Nurse	RN285409	GA

General Provider Information

NPI Number	:	1811851918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYOUNGAE LEE

Provider Business Mailing Address
First Line	:	3820 LONGLAKE DR
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-2200
Country	:	US
Telephone Number	:	954-805-9242
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 LONGLAKE DR
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-2200
Country	:	US
Telephone Number	:	954-805-9242
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ KYOUNGAE LEE ” Practice Location

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