Provider Demographics
NPI:1063040574
Name:LEE, KENNETH ALSTON (DO)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALSTON
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4660 SOUTH LINDBERGH
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127
Mailing Address - Country:US
Mailing Address - Phone:314-843-7557
Mailing Address - Fax:314-849-8671
Practice Address - Street 1:4460 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1647
Practice Address - Country:US
Practice Address - Phone:573-359-4485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020019424207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine