Basic Information
| Provider Information | |||||||||
| NPI: | 1497897730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | YONG | ||||||||
| MiddleName: | KIL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 W. 29TH STREET | ||||||||
| Address2: | LA FRONTERA CENTER | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208849920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 502 W. 29TH STREET | ||||||||
| Address2: | LA FRONTERA CENTER | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208849920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 25888 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | AL4975819 | 01 | AZ | DEA | OTHER |