Provider Demographics
NPI:1235393091
Name:LEE, KIE YUN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIE YUN
Middle Name:
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 1:4632 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-7999
Mailing Address - Country:US
Mailing Address - Phone:515-268-5522
Mailing Address - Fax:515-268-5524
Practice Address - Street 1:4632 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7999
Practice Address - Country:US
Practice Address - Phone:515-268-5522
Practice Address - Fax:515-268-5524
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18809208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAD82680Medicare UPIN