MEDICARE: DR. JANIE MOE LEE MD

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
1	2085R0202X	Diagnostic Radiology Physician	MD60375332	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J25988	OTHER	MA	BCBS MA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	217147	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1629068846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANIE MOE LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 50095
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98145-5095
Country	:	US
Telephone Number	:	206-520-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 EASTLAKE AVE E
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-4405
Country	:	US
Telephone Number	:	206-520-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	01/03/2018

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