Healthcare Provider Details

I. General information

NPI: 1518121771
Provider Name (Legal Business Name): MYUNG H LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LDS HOSPITAL 8TH AVE AND C STREET
SALT LAKE CITY UT
84143-0001
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-5060
  • Fax:
Mailing address:
  • Phone: 801-507-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number7442439-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: