Provider Demographics
NPI:1396765467
Name:LEE, MOO K (MD)
Entity type:Individual
Prefix:DR
First Name:MOO
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9115 S TACOMA WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4400
Mailing Address - Country:US
Mailing Address - Phone:253-581-4564
Mailing Address - Fax:253-581-6484
Practice Address - Street 1:9115 S TACOMA WAY STE 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4400
Practice Address - Country:US
Practice Address - Phone:253-581-4564
Practice Address - Fax:253-581-6484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA22482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1020536Medicaid
WA0097921OtherL&I
WA1020536Medicaid
WAA08701Medicare UPIN