Provider Demographics
NPI:1841281169
Name:LEE, MIN KYO (MD)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:KYO
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:315 BOULEVARD NE
Mailing Address - Street 2:STE 532
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1200
Mailing Address - Country:US
Mailing Address - Phone:404-581-0099
Mailing Address - Fax:404-581-0680
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:STE 532
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1200
Practice Address - Country:US
Practice Address - Phone:404-581-0099
Practice Address - Fax:404-581-0680
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA18310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00134461AMedicaid
GA16BDDNVMedicare ID - Type Unspecified
GA00134461AMedicaid