Provider Demographics
NPI:1962587642
Name:KONG WING LEE MD PLLC
Entity type:Organization
Organization Name:KONG WING LEE MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KONG
Authorized Official - Middle Name:WING
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-528-3888
Mailing Address - Street 1:PO BOX 3802
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-3802
Mailing Address - Country:US
Mailing Address - Phone:405-528-3888
Mailing Address - Fax:405-528-3885
Practice Address - Street 1:1119 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5646
Practice Address - Country:US
Practice Address - Phone:405-528-3888
Practice Address - Fax:405-528-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22966261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKI42192Medicare UPIN