Provider Demographics
NPI:1912368531
Name:LEE, HEE JAE (RD)
Entity Type:Individual
Prefix:MS
First Name:HEE JAE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JASON ST
Mailing Address - Street 2:APT 404
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6468
Mailing Address - Country:US
Mailing Address - Phone:781-999-1330
Mailing Address - Fax:
Practice Address - Street 1:6 JASON ST
Practice Address - Street 2:APT 404
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6468
Practice Address - Country:US
Practice Address - Phone:781-999-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3367-NU-NU133N00000X, 133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education