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General NPI Number Information
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NPI Number | 1801290994
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Entity Type | Organization
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Legal Business Name | J. W. LEE, INC.
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 10500 MONTGOMERY RD
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City | CINCINNATI
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State | OH
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Zip | 45242
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Country | US
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Telephone | 513-865-5050
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Fax | 813-865-5050
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Provider Business Mailing Address
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Address Line | 2935 THOUSAND OAKS SUITE 294
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City | SAN ANTONIO
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State | TX
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Zip | 78247-3312
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Country | US
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Telephone | 210-494-1100
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Fax | 210-494-1117
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JI WOO LEE
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Credential | M.D.
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Telephone | 513-865-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 35045945
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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