Provider Demographics
NPI:1801821541
Name:LEE, JAE M (MD)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8919 PARALLEL PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1636
Mailing Address - Country:US
Mailing Address - Phone:913-334-6800
Mailing Address - Fax:913-334-0875
Practice Address - Street 1:8919 PARALLEL PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1636
Practice Address - Country:US
Practice Address - Phone:913-334-6800
Practice Address - Fax:913-334-0875
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0415743208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0003085BMedicare ID - Type UnspecifiedMEDICARE NUMBER
KSC52144Medicare UPIN