Provider Demographics
NPI:1235461930
Name:LEE, JI YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:JI YOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
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:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B 135
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6705
Practice Address - Country:US
Practice Address - Phone:251-633-0573
Practice Address - Fax:251-633-7367
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL32475207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program