Provider Demographics
NPI:1679220016
Name:LEE, HYO JUNG (PA-C)
Entity Type:Individual
Prefix:
First Name:HYO JUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MEDICAL CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4316
Mailing Address - Country:US
Mailing Address - Phone:541-930-8900
Mailing Address - Fax:541-245-4820
Practice Address - Street 1:520 MEDICAL CENTER DR STE 300
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4316
Practice Address - Country:US
Practice Address - Phone:541-930-8900
Practice Address - Fax:541-245-4820
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-06
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA213694363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty