Provider Demographics
NPI:1790724854
Name:LEE, KWANG J (MD)
Entity Type:Individual
Prefix:DR
First Name:KWANG
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6980 SMOKE RANCH RD
Mailing Address - Street 2:STE 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8605
Mailing Address - Country:US
Mailing Address - Phone:702-732-4500
Mailing Address - Fax:702-818-1393
Practice Address - Street 1:6980 SMOKE RANCH RD
Practice Address - Street 2:STE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8605
Practice Address - Country:US
Practice Address - Phone:702-732-4500
Practice Address - Fax:702-818-1393
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-03-10
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Provider Licenses
StateLicense IDTaxonomies
NV6811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002019317Medicaid
NVV33598Medicare ID - Type Unspecified
NV002019317Medicaid