Provider Demographics
NPI:1457641870
Name:LEE, KEVIN KA YUNG
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:KA YUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N GARFIELD AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1169
Mailing Address - Country:US
Mailing Address - Phone:626-288-0889
Mailing Address - Fax:626-288-1129
Practice Address - Street 1:600 N GARFIELD AVE STE 308
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1169
Practice Address - Country:US
Practice Address - Phone:626-288-0889
Practice Address - Fax:626-288-1129
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142519208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology