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Individual

KANG K. LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(749) 446-5371
(740) 446-5711
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(749) 446-5371
(740) 446-5711

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
18084
WV
208000000X
Pediatrics Physician
Primary
35-04-5728
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000007615
ANTHEM BCBS
01
000000181980
UNISON MEDICAID
OH
01
001714077
MOUNTAIN STATE BCBS
05
0109417000
WV
01
0431894
MOLINA MEDICAID
OH
05
0431894
OH
01
310917085036
OH MEDICAID CARESOURCE
OH
01
370008780
RR MEDICARE
Enumeration date
05/31/2006
Last updated
02/21/2014
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