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General NPI Number Information
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NPI Number | 1235499229
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Entity Type | Individual
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Provider Name | JAE SEUNG LEE
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Gender | Male
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 350 W THOMAS RD
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City | PHOENIX
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State | AZ
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Zip | 85013
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Country | US
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Telephone | 602-406-3874
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Fax | 602-406-2335
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Provider Business Mailing Address
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Address Line | 3030 N CENTRAL AVE STE 1001
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City | PHOENIX
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State | AZ
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Zip | 85012-2716
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 55725
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 75669
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | S1636
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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