Provider Demographics
NPI:1679851752
Name:LEE, JI HYUN (OD)
Entity Type:Individual
Prefix:
First Name:JI HYUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JI HYUN
Other - Middle Name:LYDIA
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1865 NW 169TH PL STE 105
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7310
Mailing Address - Country:US
Mailing Address - Phone:503-533-8441
Mailing Address - Fax:503-533-8403
Practice Address - Street 1:1865 NW 169TH PL STE 105
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7310
Practice Address - Country:US
Practice Address - Phone:503-533-8441
Practice Address - Fax:503-533-8403
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3508152W00000X
MN3296152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation