Provider Demographics
NPI:1679539654
Name:LEE, KENNETH MH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MH
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 1:2021 K ST NW
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1003
Mailing Address - Country:US
Mailing Address - Phone:202-775-0955
Mailing Address - Fax:202-467-4810
Practice Address - Street 1:2021 K ST NW
Practice Address - Street 2:SUITE 315
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1003
Practice Address - Country:US
Practice Address - Phone:202-775-0955
Practice Address - Fax:202-467-4810
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC17634174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC613371Medicare UPIN
DCE51782E54Medicare PIN