Provider Demographics
NPI:1518054857
Name:LEE, KOK W (MD)
Entity Type:Individual
Prefix:
First Name:KOK
Middle Name:W
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 1:208 N GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1705
Mailing Address - Country:US
Mailing Address - Phone:626-288-8029
Mailing Address - Fax:626-288-7056
Practice Address - Street 1:208 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1705
Practice Address - Country:US
Practice Address - Phone:626-288-8029
Practice Address - Fax:626-288-7056
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC432002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C432000Medicaid
CAWC43200BOtherMEDICARE INDIVIDUAL PTAN
CAW8705DOtherMEDICARE GROUP PTAN
CA00C432000Medicaid