Healthcare Provider Details

I. General information

NPI: 1518643204
Provider Name (Legal Business Name): YOO JIN LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 GATEWAY CORP BLVD
COLUMBIA SC
29203-9611
US

IV. Provider business mailing address

2180 PICKENS ST UNIT 2-330
COLUMBIA SC
29201-2786
US

V. Phone/Fax

Practice location:
  • Phone: 803-865-4831
  • Fax:
Mailing address:
  • Phone: 917-227-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number97424
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: