Provider Demographics
NPI:1881660470
Name:LEE, ABRAHAM KYUNG HO (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:KYUNG HO
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 1:630 E STAR CT
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6702
Mailing Address - Country:US
Mailing Address - Phone:970-240-0378
Mailing Address - Fax:970-240-3346
Practice Address - Street 1:630 E STAR CT
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6702
Practice Address - Country:US
Practice Address - Phone:970-240-0378
Practice Address - Fax:970-240-3346
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H62265Medicare UPIN
CO92836861Medicare ID - Type Unspecified
CO465270Medicare ID - Type Unspecified