Provider Demographics
NPI:1720034358
Name:LEE, MOYUEN MIMI (MD)
Entity Type:Individual
Prefix:PROF
First Name:MOYUEN
Middle Name:MIMI
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 CANTRELL RD
Mailing Address - Street 2:PLAZA 80
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2423
Mailing Address - Country:US
Mailing Address - Phone:501-224-0880
Mailing Address - Fax:501-224-1395
Practice Address - Street 1:8315 CANTRELL RD
Practice Address - Street 2:PLAZA 80
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2423
Practice Address - Country:US
Practice Address - Phone:501-224-0880
Practice Address - Fax:501-224-1395
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2338208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00037405OtherRAILROAD MEDICARE
AR188290000000OtherQUALCHOICE
AR5L347OtherARKANSAS BLUE CROSS AND BLUE SHIELD
AR188290000000OtherQUALCHOICE
AR5L347F979Medicare PIN
ARP00037405OtherRAILROAD MEDICARE