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General NPI Number Information
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NPI Number | 1588150288
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Entity Type | Individual
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Provider Name | JANE SOOHYUN LEE MD
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Gender | Female
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 4961 LACLEDE AVE APT 205
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1436
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Country | US
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Telephone | 314-480-0110
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Fax |
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Provider Business Mailing Address
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Address Line | 4961 LACLEDE AVE APT 205
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1436
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Country | US
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Telephone | 314-480-0110
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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 | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | 80058-20
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License Number State | WI
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