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General NPI Number Information
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NPI Number | 1457762304
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Entity Type | Individual
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Provider Name | ANNA JIYOUNG LEE-MULAY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 09/09/2018
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Provider Practice Location Address
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Address Line | 1575 PARR AVE STE B
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-286-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 PARR AVE STE B
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City | DYERSBURG
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State | TN
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Zip | 38024-3151
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Country | US
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Telephone | 731-286-1510
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 65894-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD0000057280
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License Number State | TN
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