Lee, Kyoung Kelly

Lee, Kyoung Kelly is an individual health care provider with primary practice located at 3300 West Centre Ave Bronson Ob/Gyn Associates, Portage MI 49024. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology, which is considered as her primary health care specialty. Lee, Kyoung Kelly can be contacted via phone (269) 327-2211.

Contact Information

Primary practice address
3300 West Centre Ave Bronson Ob/Gyn Associates Portage MI 49024
Fax: (269) 327-0273
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology 363LX0001X 4704247830 Michigan

Profile Details

NPI number 1790765139
LBN Legal business name Lee, Kyoung Kelly
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 20th, 2006
Last updated Jul 8th, 2007 - about 14 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 1790765139 NPPES
Michigan MEDICAID 4770217

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