Provider Demographics
NPI:1780635813
Name:LEE, KUK SEUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:KUK
Middle Name:SEUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 HIGHLAND PARK DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401
Mailing Address - Country:US
Mailing Address - Phone:724-437-4008
Mailing Address - Fax:724-437-4009
Practice Address - Street 1:20 HIGHLAND PARK DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-437-4008
Practice Address - Fax:724-437-4009
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045005E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012983510006Medicaid
PA701307Medicare ID - Type Unspecified
PA0012983510006Medicaid