Provider Demographics
NPI:1104818251
Name:LEE, SONG DOW (MD)
Entity type:Individual
Prefix:DR
First Name:SONG
Middle Name:DOW
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SW FAIRLAWN RD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2232
Mailing Address - Country:US
Mailing Address - Phone:785-273-3234
Mailing Address - Fax:
Practice Address - Street 1:823 SW MULVANE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1679
Practice Address - Country:US
Practice Address - Phone:785-235-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15981174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100082550AMedicaid
KS050022969OtherPALMETTO GBA RR MEDICARE
KS000854Medicare PIN
KSB69160Medicare UPIN