Provider Demographics
NPI:1598984254
Name:LEE, JAMES TE-AN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TE-AN
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 1:800 ROSE ST
Mailing Address - Street 2:HX316
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-2506
Mailing Address - Fax:859-257-4457
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:HX316
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-5069
Practice Address - Fax:859-257-4457
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR09352085R0202X
CAA 1068252085U0001X
TXN64542085R0202X
KY446602085R0202X, 2085U0001X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100018710Medicaid
KYK009260Medicare PIN
KY0928809Medicare PIN
CABY262XMedicare PIN