Lee, Kwang Soo

Lee, Kwang Soo is an sole proprietor health care provider with primary practice located at 221 Broadway Suite 303, Amityville NY 11701. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Lee, Kwang Soo can be contacted via phone (631) 789-7448.

Contact Information

Primary practice address
221 Broadway Suite 303 Amityville NY 11701
Phone: (631) 789-7448
Fax: (631) 789-8571
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 119206 New York

Profile Details

NPI number 1295893394
LBN Legal business name Lee, Kwang Soo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 4th, 2006
Last updated Mar 15th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295893394 NPPES
New York MEDICAID 00763828

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