Provider Demographics
NPI:1851661953
Name:S. KWON LEE, MD, INC
Entity Type:Organization
Organization Name:S. KWON LEE, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:KWON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-242-8499
Mailing Address - Street 1:PO BOX 583211
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-0057
Mailing Address - Country:US
Mailing Address - Phone:916-242-8499
Mailing Address - Fax:916-405-7440
Practice Address - Street 1:7807 LAGUNA BLVD STE 480
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7953
Practice Address - Country:US
Practice Address - Phone:916-242-8499
Practice Address - Fax:916-405-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54971208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty