Provider Demographics
NPI:1033230933
Name:LEE, EUGENE KANG (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:KANG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 3016
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8500
Mailing Address - Country:US
Mailing Address - Phone:913-588-7564
Mailing Address - Fax:913-588-6668
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 3016
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-7564
Practice Address - Fax:913-588-6668
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36419208800000X
MO2013015498208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297895901Medicaid
TX297895901Medicaid