Doctor Name: | MR. KYUNG WOON LEE |
NPI Number: | 1295142149 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | RN211429 |
Business Practice Address: | 148 E Peacock St Cochran, GA - 310147847 |
Business Phone Number: | 4789344988 |
Business Fax Number: | 4789344989 |
Mailing Address: | 148 E Peacock St, COCHRAN |
State: | GA |
Postal Code: | 310147847 |
Phone Number: | 4789344988 |
Fax Number: | 4789344989 |
NPI Enumeration Date: | 07/11/2014 |
NPI Last Update Date: | 01/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN211429 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |