Provider Demographics
NPI:1750826863
Name:LEE, KENNETH KAMKIN (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:KAMKIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4141 E CIELO PRIVADO
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2740
Mailing Address - Country:US
Mailing Address - Phone:443-832-9673
Mailing Address - Fax:443-319-1959
Practice Address - Street 1:4141 E CIELO PRIVADO
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2740
Practice Address - Country:US
Practice Address - Phone:443-832-9673
Practice Address - Fax:443-319-1959
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2024-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0081323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine