Provider Demographics
NPI:1598866907
Name:JAE YONG LEE DO LLC
Entity Type:Organization
Organization Name:JAE YONG LEE DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:YONG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-699-3197
Mailing Address - Street 1:14100 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4028
Mailing Address - Country:US
Mailing Address - Phone:303-699-3197
Mailing Address - Fax:303-699-3186
Practice Address - Street 1:14100 E ARAPAHOE RD
Practice Address - Street 2:SUITE 360
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4028
Practice Address - Country:US
Practice Address - Phone:303-699-3197
Practice Address - Fax:303-699-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC516778Medicare UPIN
COH98411Medicare UPIN
COH98411Medicare UPIN