Provider Demographics
NPI:1669580478
Name:LEE, JAE YOUNG (MD)
Entity type:Individual
Prefix:
First Name:JAE YOUNG
Middle Name:
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 1:200 HAWKINS DRIVE
Mailing Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-356-3375
Mailing Address - Fax:319-356-2220
Practice Address - Street 1:200 HAWKINS DRIVE
Practice Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-356-3375
Practice Address - Fax:319-356-2220
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IASP1812085B0100X, 2085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0729459Medicaid
IA20606OtherWELLMARK BCBS
IAI18368Medicare ID - Type Unspecified
IA20606OtherWELLMARK BCBS
IA0729459Medicaid