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1578010815 NPI number — JIHWAN LEE DPT

NPI Number: 1578010815
Health Care Provider/Practitioner: JIHWAN LEE DPT

Information about “1578010815” NPI (JIHWAN LEE DPT) exists in 1578010815 in HTML format HTML  |  1578010815 in plain Text format TXT  |  1578010815 in PDF (Portable Document Format) PDF  |  1578010815 in an XML format XML  formats.

NPI Number : 1578010815 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578010815",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEE",
    "FirstName": "JIHWAN",
    "MiddleName": null,
    "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": "2832 NOLINA LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROUND ROCK",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78681-2457",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "646-500-0538",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "16333 S GREAT OAKS DR STE 122",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ROUND ROCK",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78681-3601",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "646-500-0538",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/03/2016",
    "LastUpdateDate": "09/02/2025",
    "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": "2251X0800X",
        "TaxonomyName": "Orthopedic Physical Therapist",
        "LicenseNumber": "1399272",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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