Provider Demographics
NPI:1336153113
Name:KEVIN K. LEE, M.D., P.C.
Entity Type:Organization
Organization Name:KEVIN K. LEE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-643-4663
Mailing Address - Street 1:1227 WARM SPRINGS AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2300
Mailing Address - Country:US
Mailing Address - Phone:814-643-4663
Mailing Address - Fax:814-643-9273
Practice Address - Street 1:1227 WARM SPRINGS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2300
Practice Address - Country:US
Practice Address - Phone:814-643-4663
Practice Address - Fax:814-643-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001283706Medicaid
PA721132Medicare ID - Type Unspecified