Healthcare Provider Details

I. General information

NPI: 1871243048
Provider Name (Legal Business Name): JERRY YUAN-HO LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 NE 128TH ST
KIRKLAND WA
98034-3098
US

IV. Provider business mailing address

14751 N KELSEY ST STE 105
MONROE WA
98272-1458
US

V. Phone/Fax

Practice location:
  • Phone: 949-331-5335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.MD.70095952
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: