Provider Demographics
NPI:1053035832
Name:LEE, KHANGEUN ASHLEY
Entity type:Individual
Prefix:
First Name:KHANGEUN
Middle Name:ASHLEY
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N XENOPHON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-6525
Mailing Address - Country:US
Mailing Address - Phone:405-609-9958
Mailing Address - Fax:
Practice Address - Street 1:321 N XENOPHON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-6525
Practice Address - Country:US
Practice Address - Phone:405-609-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program