Provider Demographics
NPI:1861675845
Name:LEE, KIL BOO (MD)
Entity Type:Individual
Prefix:DR
First Name:KIL
Middle Name:BOO
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1777 MONTREAL CIR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6802
Mailing Address - Country:US
Mailing Address - Phone:770-934-9200
Mailing Address - Fax:770-621-7530
Practice Address - Street 1:1777 MONTREAL CIR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6802
Practice Address - Country:US
Practice Address - Phone:770-934-9200
Practice Address - Fax:770-621-7530
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051247207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG62442Medicare UPIN