1447615570 NPI number — JAE YOUNG LEE RN

Table of content: JAE YOUNG LEE RN (NPI 1447615570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447615570 NPI number — JAE YOUNG LEE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
JAE YOUNG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
JAE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447615570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6500 W NEWBERRY RD
Provider Second Line Business Mailing Address:
CARDIOVASCULAR UNIT
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32605-4309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-333-5521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6500 W NEWBERRY RD
Provider Second Line Business Practice Location Address:
CARDIOVASCULAR UNIT
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32605-4309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-333-5521
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0200X , with the licence number:  RN9348578 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)