Provider Demographics
NPI:1306129499
Name:LEE, KWOK S
Entity type:Individual
Prefix:
First Name:KWOK
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 SW DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8401
Mailing Address - Country:US
Mailing Address - Phone:503-639-0722
Mailing Address - Fax:503-639-4970
Practice Address - Street 1:7850 SW DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8401
Practice Address - Country:US
Practice Address - Phone:503-639-0722
Practice Address - Fax:503-639-4970
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8653183500000X
OR000086531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist