1255353694 NPI number — DR. JOSEPH Y LEE D.O.

Table of content: DR. JOSEPH Y LEE D.O. (NPI 1255353694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255353694 NPI number — DR. JOSEPH Y LEE D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
JOSEPH
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255353694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 SHINGLE CREEK PKWY
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55430-2128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-561-5349
Provider Business Mailing Address Fax Number:
763-561-7792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2085 RICE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55113-6807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-489-9035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2006

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: 207RN0300X , with the licence number:  41198 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 135419C028 . This is a "U-CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 877G6LE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1046268 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3100324 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP60190 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 539137700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43528800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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