Provider Demographics
NPI:1598463051
Name:LEE, JADE CHING-LIN (MS, RD)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:CHING-LIN
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 MONTEVISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8273
Mailing Address - Country:US
Mailing Address - Phone:253-218-9326
Mailing Address - Fax:
Practice Address - Street 1:401 LITTLE TEXAS LN APT 2531
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4188
Practice Address - Country:US
Practice Address - Phone:253-218-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87712133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered