Provider Demographics
NPI:1942568068
Name:LEE, KEVIN BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRIAN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 NICOLLS RD
Mailing Address - Street 2:HEALTH SCIENCES CENTER L4-060
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794
Mailing Address - Country:US
Mailing Address - Phone:631-444-2078
Mailing Address - Fax:631-638-1199
Practice Address - Street 1:100 NICOLLS RD
Practice Address - Street 2:HEALTH SCIENCES CENTER L4-060
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794
Practice Address - Country:US
Practice Address - Phone:631-444-2078
Practice Address - Fax:631-638-1199
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY281395207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program