MEDICARE: LEE KIEN YONG 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	207RI0200X	Infectious Disease Physician	2011001240	MO
2	207RI0200X	Infectious Disease Physician	036123437	IL

General Provider Information

NPI Number	:	1952538522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE KIEN YONG M.D.

Provider Business Mailing Address
First Line	:	335 OAK STAND CT
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1310
Country	:	US
Telephone Number	:	636-751-2042
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 1ST CAPITOL DR STE 260
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2888
Country	:	US
Telephone Number	:	636-925-0900
Fax Number	:	636-925-0960

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

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	07/19/2021

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