Provider Demographics
NPI:1629579479
Name:LEE, SE RIN (MD)
Entity Type:Individual
Prefix:
First Name:SE RIN
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 1:984125 NEBRASKA MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-4125
Mailing Address - Country:US
Mailing Address - Phone:402-559-5999
Mailing Address - Fax:
Practice Address - Street 1:984125 NEBRASKA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4125
Practice Address - Country:US
Practice Address - Phone:402-559-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9613204E00000X
IL019.031841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery