Provider Demographics
NPI:1134127764
Name:LEE, KENNETH JIANN-HUNG (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JIANN-HUNG
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:PO BOX 301528
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75303-1528
Mailing Address - Country:US
Mailing Address - Phone:713-554-5304
Mailing Address - Fax:713-554-5324
Practice Address - Street 1:16929 SW FREEWAY #100
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:713-774-6337
Practice Address - Fax:281-313-7747
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2377207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1419Medicare PIN