Provider Demographics
NPI:1477550986
Name:LEE, KWOK C (MD)
Entity Type:Individual
Prefix:DR
First Name:KWOK
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0646
Mailing Address - Country:US
Mailing Address - Phone:301-665-4661
Mailing Address - Fax:301-695-7750
Practice Address - Street 1:501 W 7TH ST
Practice Address - Street 2:STE 2
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4507
Practice Address - Country:US
Practice Address - Phone:240-566-3400
Practice Address - Fax:301-694-5554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00240312085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE11541Medicare UPIN
MD795YMedicare ID - Type Unspecified