Provider Demographics
NPI:1639161243
Name:LEE, KENNETH THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:THOMAS
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1180 N INDIAN CANYON DR
Mailing Address - Street 2:STE E205
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4800
Mailing Address - Country:US
Mailing Address - Phone:760-325-1202
Mailing Address - Fax:760-864-7105
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:STE E205
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-325-1202
Practice Address - Fax:760-864-7105
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-11-29
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Provider Licenses
StateLicense IDTaxonomies
TXP4976208G00000X
CAA97229208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI17016Medicare UPIN