Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | K6088 | TX |
NPI | 1124000823 |
---|---|
Provider Name | Dr. Kang Sun Lee |
First Address | Corpus Christi, TX 78414-6053 |
Second Address | Corpus Christi, TX 78414-6053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 09/06/2011 |