Provider Demographics
NPI:1326257346
Name:LEE, DANIEL KWAI (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KWAI
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 1:1717 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4543
Mailing Address - Country:US
Mailing Address - Phone:319-233-0340
Mailing Address - Fax:319-233-0666
Practice Address - Street 1:1717 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-233-0340
Practice Address - Fax:319-233-0666
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37395208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA70308OtherBLUE CROSS BLUE SHIELD IA
IA253990OtherMIDLANDS CHOICE
IA1326257346Medicaid
P00424555OtherRR MEDICARE
IAI21095Medicare PIN