Healthcare Provider Details

I. General information

NPI: 1558543538
Provider Name (Legal Business Name): GEORGE Y. LEE, MD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 116TH AVE NE SUITE 111
BELLEVUE WA
98004-3010
US

IV. Provider business mailing address

16416 SE 66TH ST
BELLEVUE WA
98006-5433
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-7982
  • Fax: 208-666-1642
Mailing address:
  • Phone: 706-264-4446
  • Fax: 208-666-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License NumberMD00047144
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00047144
License Number StateWA

VIII. Authorized Official

Name: DR. GEORGE Y LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 706-264-4446