Provider Demographics
NPI:1851350995
Name:LEE, DANNY KIM (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:KIM
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 1:3501 MEMORIAL PKWY SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5319
Mailing Address - Country:US
Mailing Address - Phone:256-533-0315
Mailing Address - Fax:256-536-0360
Practice Address - Street 1:3501 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5319
Practice Address - Country:US
Practice Address - Phone:256-533-0315
Practice Address - Fax:256-536-0360
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058065207W00000X
ALMD26750207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDGQFOtherMEDICARE ID
GA991487761AMedicaid
GAC30849Medicare PIN
H70459Medicare UPIN
GA00965Medicare PIN