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1548314313 NPI number — THOMAS KEYWON LEE MD, PHD

NPI Number: 1548314313
Health Care Provider/Practitioner: THOMAS KEYWON LEE MD, PHD

Information about “1548314313” NPI (THOMAS KEYWON LEE MD, PHD) exists in 1548314313 in HTML format HTML  |  1548314313 in plain Text format TXT  |  1548314313 in PDF (Portable Document Format) PDF  |  1548314313 in an XML format XML  formats.

NPI Number : 1548314313 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548314313",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEE",
    "FirstName": "THOMAS",
    "MiddleName": "KEYWON",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD, PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2901 W COAST HWY STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWPORT BEACH",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92663-4045",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "949-891-1297",
    "MailingAddressFaxNumber": "949-625-8010",
    "FirstLinePracticeLocationAddress": "1 HOAG DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWPORT BEACH",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92663-4162",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "949-764-4624",
    "PracticeLocationAddressFaxNumber": "949-764-5435",
    "EnumerationDate": "01/22/2007",
    "LastUpdateDate": "02/10/2020",
    "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": "207ZP0102X",
          "TaxonomyName": "Anatomic Pathology & Clinical Pathology Physician",
          "LicenseNumber": "A106146",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207ZP0101X",
          "TaxonomyName": "Anatomic Pathology Physician",
          "LicenseNumber": "T1602",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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