Healthcare Provider Details

I. General information

NPI: 1194592139
Provider Name (Legal Business Name): DAMIEN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 JASONWAY AVE
COLUMBUS OH
43214-2447
US

IV. Provider business mailing address

659 JASONWAY AVE
COLUMBUS OH
43214-2447
US

V. Phone/Fax

Practice location:
  • Phone: 614-989-7337
  • Fax:
Mailing address:
  • Phone: 614-989-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: