Healthcare Provider Details

I. General information

NPI: 1023691011
Provider Name (Legal Business Name): JASON LEE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 S 3000 E STE 100
SALT LAKE CITY UT
84121-6924
US

IV. Provider business mailing address

1345 N 1020 E
AMERICAN FORK UT
84003-3234
US

V. Phone/Fax

Practice location:
  • Phone: 801-365-1032
  • Fax: 801-365-1036
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14211321-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number14211321-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: