Provider Demographics
NPI:1386759637
Name:LEE, KWANG W (MD)
Entity type:Individual
Prefix:
First Name:KWANG
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:100 N 20TH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-977-8100
Mailing Address - Fax:215-977-8351
Practice Address - Street 1:34TH STREET & CIVIC CENTER BLVD
Practice Address - Street 2:SUITE 9329
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-590-1858
Practice Address - Fax:215-977-8351
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD033069L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006841010Medicaid
PA148182Medicare ID - Type Unspecified
PAC31871Medicare UPIN