Provider Demographics
NPI:1164724647
Name:VERNON Y.J. LEE DO P.C.
Entity Type:Organization
Organization Name:VERNON Y.J. LEE DO P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:YJ
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-252-0550
Mailing Address - Street 1:9141 GRANT ST STE 245
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4367
Mailing Address - Country:US
Mailing Address - Phone:303-252-0550
Mailing Address - Fax:
Practice Address - Street 1:9141 GRANT ST STE 245
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4367
Practice Address - Country:US
Practice Address - Phone:303-252-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD49823Medicare UPIN