Basic Information
| Provider Information | |||||||||
| NPI: | 1740308147 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAWN K LEE MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4140 W MEMORIAL RD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057554290 | ||||||||
| FaxNumber: | 4057557773 | ||||||||
| Practice Location | |||||||||
| Address1: | 4140 W MEMORIAL RD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731208366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057554290 | ||||||||
| FaxNumber: | 4057557773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | BANKSTON | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4057557672 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 19842 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | $$$$$$$$$ | 01 | OK | SOCIAL SECURITY # | OTHER | 100126510B | 05 | OK | MEDICAID |