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General NPI Number Information
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NPI Number | 1023691011
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Entity Type | Individual
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Provider Name | JASON LEE DO
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Gender | Male
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 6360 S 3000 E STE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-6924
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Country | US
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Telephone | 801-365-1032
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Fax | 801-365-1036
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Provider Business Mailing Address
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Address Line | 1345 N 1020 E
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City | AMERICAN FORK
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State | UT
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Zip | 84003-3234
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 14211321-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14211321-1204
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License Number State | UT
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