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General NPI Number Information
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NPI Number | 1639268436
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Entity Type | Organization
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Legal Business Name | Y J LEE GASTROENTEROLOGY, PC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 3855 PLEASANT HILL RD SUITE 260
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City | DULUTH
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State | GA
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Zip | 30096-1407
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Country | US
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Telephone | 678-473-1445
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1924
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City | DULUTH
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State | GA
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Zip | 30096-0034
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Country | US
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Telephone | 678-473-1445
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YOON JAE LEE
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Credential | MD
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Telephone | 678-473-1445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 051971
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License Number State | GA
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