Provider Demographics
NPI:1659525244
Name:LEE, KEVIN SUK JAE (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:SUK JAE
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 1:103 SANDY PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-8214
Mailing Address - Country:US
Mailing Address - Phone:917-837-7747
Mailing Address - Fax:
Practice Address - Street 1:2215 BURDETT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2475
Practice Address - Country:US
Practice Address - Phone:518-525-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-09
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243169207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology