Provider Demographics
NPI:1306871272
Name:LEE, KENNETH YUN
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:YUN
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 1:1229 MADISON ST
Mailing Address - Street 2:SUITE 1440
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3586
Mailing Address - Country:US
Mailing Address - Phone:206-625-0578
Mailing Address - Fax:206-625-9184
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:SUITE 1440
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-625-0578
Practice Address - Fax:206-625-9184
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044908207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1321LEOtherB/S REGENCE 90
WA8431116Medicaid
198620OtherL&I
1321LEOtherB/S REGENCE 90
I34041Medicare UPIN