Provider Demographics
NPI:1265461610
Name:LEE, DANIEL JIN (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JIN
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:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-648-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2256372085N0904X, 2085R0202X
LA3117062085N0904X, 2085R0202X
TXU1706207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005077333OtherHEALTH NOW - UMI
NY02526974Medicaid
NYGP0091OtherPREFERRED CARE - UMI
NYMDH779OtherPREFERRED CARE
NYP00262486OtherRAILROAD MEDICARE
NY050106000087OtherFIDELIS
NY4124852OtherMVP - UMI
NYP010225637OtherBLUE CHOICE
NY050106000089OtherFIDELIS - UMI
NY00026794601OtherUNIVERA
NY00026794602OtherUNIVERA
NY005077331OtherHEALTN NOW
NY4124851OtherMVP
NY7821591OtherAETNA