Provider Demographics
NPI:1801052311
Name:LEE, KWAN HA
Entity type:Individual
Prefix:MR
First Name:KWAN
Middle Name:HA
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2442 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1700
Mailing Address - Country:US
Mailing Address - Phone:678-417-0100
Mailing Address - Fax:678-417-0100
Practice Address - Street 1:2442 PLEASANT HILL ROAD
Practice Address - Street 2:SUITE 4
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1700
Practice Address - Country:US
Practice Address - Phone:678-417-0100
Practice Address - Fax:678-417-0100
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist