Provider Demographics
NPI:1386619112
Name:SHUNG-MAN KURT LEE MDPA
Entity type:Organization
Organization Name:SHUNG-MAN KURT LEE MDPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHUNG MAN
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-892-1003
Mailing Address - Street 1:PO BOX 12435
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2435
Mailing Address - Country:US
Mailing Address - Phone:409-892-1003
Mailing Address - Fax:
Practice Address - Street 1:2965 HARRISON ST
Practice Address - Street 2:STE 222
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1100
Practice Address - Country:US
Practice Address - Phone:409-892-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081418801Medicaid
TX081418801Medicaid