Individual
KANGWEON LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
19 DODGE ST, BEVERLY, MA 01915-1705
(857) 344-0545
Mailing address
19 DODGE ST, BEVERLY, MA 01915-1705
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2340947
MA
363L00000X
Nurse Practitioner
RN2340947
MA
363LF0000X
Family Nurse Practitioner
Primary
RN2340947
MA
Other
Enumeration date
03/03/2021
Last updated
08/24/2025
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