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General NPI Number Information
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NPI Number | 1740787514
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Entity Type | Individual
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Provider Name | JACQUELYNN T LEE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 2724 N TENAYA WAY FL 2
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City | LAS VEGAS
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State | NV
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Zip | 89128-0424
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Country | US
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Telephone | 702-671-5110
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Fax |
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Provider Business Mailing Address
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Address Line | 3016 W CHARLESTON BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89102-1973
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Country | US
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Telephone |
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 27630
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 2024013118
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | BP1-0063431
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 27630
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License Number State | NV
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