MEDICARE: KONG WING LEE MD PLLC

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	261QM2500X	Medical Specialty Clinic/Center	22966	OK

General Provider Information

NPI Number	:	1962587642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KONG WING LEE MD PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3802
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73083-3802
Country	:	US
Telephone Number	:	405-528-3888
Fax Number	:	405-528-3885

Provider Business Practice Location Address
First Line	:	1119 NW 25TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5646
Country	:	US
Telephone Number	:	405-528-3888
Fax Number	:	405-528-3885

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	KONG WING LEE
Credential	:	M.D.
Telephone Number	:	405-528-3888

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	01/02/2008

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