Provider Demographics
NPI:1275881419
Name:LEE, KAN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAN
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19614 CLUB HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3035
Mailing Address - Country:US
Mailing Address - Phone:301-963-0519
Mailing Address - Fax:301-963-0513
Practice Address - Street 1:19614 CLUB HOUSE RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3035
Practice Address - Country:US
Practice Address - Phone:301-963-0519
Practice Address - Fax:301-963-0513
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1790291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory