Provider Demographics
NPI:1043299217
Name:KEE, ANDREW YOO JONG (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:YOO JONG
Last Name:KEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NW 22ND AVE STE LL50
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2900
Mailing Address - Country:US
Mailing Address - Phone:503-413-7135
Mailing Address - Fax:503-413-8363
Practice Address - Street 1:1130 NW 22ND AVE STE LL50
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2900
Practice Address - Country:US
Practice Address - Phone:503-413-7135
Practice Address - Fax:503-413-8363
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD281842085R0203X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN291961300Medicaid
WI001920345Medicare ID - Type UnspecifiedOUTREACH
MNP00106397Medicare ID - Type UnspecifiedRAILROAD
OR141835Medicare PIN
OR141595Medicare PIN
MN920000251Medicare ID - Type Unspecified
H84095Medicare UPIN
MN291961300Medicaid