Provider Demographics
NPI:1538133764
Name:LEE, KENNETH K (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:K
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 1:3550 TERRACE STREET
Mailing Address - Street 2:497 SCAIFE HALL
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261-0001
Mailing Address - Country:US
Mailing Address - Phone:412-647-0457
Mailing Address - Fax:
Practice Address - Street 1:3550 TERRACE STREET
Practice Address - Street 2:497 SCAIFE HALL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-0001
Practice Address - Country:US
Practice Address - Phone:412-647-0457
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042705E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE23611Medicare UPIN
PA567996FKYMedicare ID - Type Unspecified