Provider Demographics
NPI:1861467037
Name:LEE, JAI H (MD)
Entity Type:Individual
Prefix:
First Name:JAI
Middle Name:H
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 1:75 ARCH ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1429
Mailing Address - Country:US
Mailing Address - Phone:330-384-9001
Mailing Address - Fax:330-384-9002
Practice Address - Street 1:7255 OLD OAK BLVD STE B-311
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3329
Practice Address - Country:US
Practice Address - Phone:440-816-2638
Practice Address - Fax:440-816-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.059614208G00000X
WI3571208G00000X
IN01091850A208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0895018Medicaid
F02709Medicare UPIN
OH0895018Medicaid