Provider Demographics
NPI:1720250079
Name:LEE, MIN KYU (MD)
Entity Type:Individual
Prefix:DR
First Name:MIN
Middle Name:KYU
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:ROOM 5512
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-5161
Mailing Address - Fax:310-423-0436
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:ROOM 5512
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-5161
Practice Address - Fax:310-423-0436
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101662207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine