Provider Demographics
NPI:1497897730
Name:LEE, YONG KIL (MD)
Entity Type:Individual
Prefix:MR
First Name:YONG
Middle Name:KIL
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 1:502 W. 29TH STREET
Mailing Address - Street 2:LA FRONTERA CENTER
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713
Mailing Address - Country:US
Mailing Address - Phone:520-884-9920
Mailing Address - Fax:
Practice Address - Street 1:502 W. 29TH STREET
Practice Address - Street 2:LA FRONTERA CENTER
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713
Practice Address - Country:US
Practice Address - Phone:520-884-9920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL4975819OtherDEA
AZAL4975819OtherDEA
AZE37426Medicare UPIN