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NPI Code Detail

MEDICARE: JIN GYU LEE

MEDICARE:   JIN GYU LEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367H00000XAnesthesiologist Assistant

General Provider Information

NPI Number : 1235061433
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIN GYU LEE
Provider Business Mailing Address
First Line : 644 VALLEY GLEN DR
Second Line :
City : DACULA
State : GA
Zip : 30019-7905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1364 CLIFTON RD NE # AT
Second Line :
City : ATLANTA
State : GA
Zip : 30322-1059
Country : US
Telephone Number : 404-712-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ JIN GYU LEE ” Practice Location

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