Provider Demographics
NPI:1053128231
Name:LEE, SEUNG KI
Entity type:Individual
Prefix:
First Name:SEUNG
Middle Name:KI
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 SATELLITE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-0754
Mailing Address - Country:US
Mailing Address - Phone:614-270-9894
Mailing Address - Fax:
Practice Address - Street 1:1401 ARVILLE ST STE G
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0537
Practice Address - Country:US
Practice Address - Phone:702-738-0515
Practice Address - Fax:702-527-7698
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant