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1194060095 NPI number — ALBERT JONG-SUK LEE DPT

NPI Number: 1194060095
Health Care Provider/Practitioner: ALBERT JONG-SUK LEE DPT

Information about “1194060095” NPI (ALBERT JONG-SUK LEE DPT) exists in 1194060095 in HTML format HTML  |  1194060095 in plain Text format TXT  |  1194060095 in PDF (Portable Document Format) PDF  |  1194060095 in an XML format XML  formats.

NPI Number : 1194060095 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194060095",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEE",
    "FirstName": "ALBERT",
    "MiddleName": "JONG-SUK",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9300 DEWITT LOOP",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FT BELVOIR",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22060-5285",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-231-2198",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9300 DEWITT LOOP",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FT BELVOIR",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22060-5285",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-231-2198",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/03/2012",
    "LastUpdateDate": "04/30/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "24118",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2251X0800X",
          "TaxonomyName": "Orthopedic Physical Therapist",
          "LicenseNumber": "PT31107",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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