1316007867 NPI number — DR. YI SHIUAN JUDY LEE MD PHD

Table of content: DR. YI SHIUAN JUDY LEE MD PHD (NPI 1316007867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316007867 NPI number — DR. YI SHIUAN JUDY LEE MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
YI SHIUAN
Provider Middle Name:
JUDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
F

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:
1316007867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2169 JOLLY RD
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
OKEMOS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48864-3992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-347-8228
Provider Business Mailing Address Fax Number:
517-347-8287

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2169 JOLLY RD
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-3992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-347-8228
Provider Business Practice Location Address Fax Number:
517-347-8287
Provider Enumeration Date:
12/12/2006

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: 207L00000X , with the licence number:  4301066320 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 4301066320 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0503302562 . This is a "BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00055007 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7823128 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: M0171703 . This is a "TRICARE PGBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 122833 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 122833 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2692375 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000008690 . This is a "CAPE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2000053 . This is a "PHP" identifier . This identifiers is of the category "OTHER".




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