Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD19438 | OR |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD19438 | OR |
NPI | 1407864937 |
---|---|
Provider Name | Dr. Ken Kyung-Hoon Lee |
First Address | Portland, OR 97232-2686 |
Second Address | Portland, OR 97209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151115 | (05) | OR |
F57314 | (02) |