Active NPI
Kyu Chan Lee, M.D.
- Physical Medicine & Rehabilitation Physician
- Columbia, SC
National Provider Identifier
1205813144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- D0023629
- Practice address
- 4500 Stuart Ave # 9-34
Columbia, SC 29207-5700 - Phone
- (803) 751-0456
- NPI assigned
- Dec 30, 2005
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | D0023629 | MD | Primary |
Addresses
Primary practice location
4500 Stuart Ave # 9-34
Columbia, SC 29207-5700
Mailing address
4500 Stuart Street
Moncriefahc 9-34, Fort Jackson
Columbia, SC 29207
Phone (803) 751-0456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 397781100 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0023629 | MD | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1205813144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 STUART STREET",
"address_2": "MONCRIEFAHC 9-34, FORT JACKSON",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29207",
"telephone_number": "803-751-0456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 STUART AVE # 9-34",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292075700",
"telephone_number": "803-751-0456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KYU",
"middle_name": "CHAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-30",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "MD",
"license": "D0023629",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "397781100",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.