Provider Demographics
NPI:1093777096
Name:LEE, SHAWN JOON (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:JOON
Last Name:LEE
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 1:1231 116TH AVE NE STE 700
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3836
Mailing Address - Country:US
Mailing Address - Phone:425-451-3043
Mailing Address - Fax:425-451-3044
Practice Address - Street 1:1231 116TH AVE NE STE 700
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3836
Practice Address - Country:US
Practice Address - Phone:425-451-3043
Practice Address - Fax:425-451-3044
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2987LEOtherREGENCE BLUESHIELD RIDER
WA110227107OtherRAILROAD MEDICARE
WA8279622Medicaid
WA0150787OtherL & I WORKERS COMP
WA110227107OtherRAILROAD MEDICARE
WAAB23671Medicare ID - Type Unspecified