Provider Demographics
NPI:1891495511
Name:LEE, JAEWOO
Entity Type:Individual
Prefix:
First Name:JAEWOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 HARRISON AVE APT 23
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1858
Mailing Address - Country:US
Mailing Address - Phone:617-909-8945
Mailing Address - Fax:
Practice Address - Street 1:231 HARRISON AVE APT 23
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1858
Practice Address - Country:US
Practice Address - Phone:617-909-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program