Provider Demographics
NPI:1598957169
Name:KANG HOON LEE MD PC
Entity Type:Organization
Organization Name:KANG HOON LEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-845-7387
Mailing Address - Street 1:7 N ATKINSON DR
Mailing Address - Street 2:SUITE 113
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1953
Mailing Address - Country:US
Mailing Address - Phone:231-845-7387
Mailing Address - Fax:
Practice Address - Street 1:7 N ATKINSON DR
Practice Address - Street 2:SUITE 113
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1953
Practice Address - Country:US
Practice Address - Phone:231-845-7387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI031493207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1070449Medicaid
MI1070449Medicaid
MIB46947Medicare UPIN