Basic Information
| Provider Information | |||||||||
| NPI: | 1093777096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | JOON | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3905 | ||||||||
| Address2: | DEPT. 4204 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981243905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605149060 | ||||||||
| FaxNumber: | 3605149041 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 116TH AVE NE | ||||||||
| Address2: | HOSPITALIST DEPT. | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980044604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256885072 | ||||||||
| FaxNumber: | 4254673310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD00040019 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8279622 | 05 | WA | MEDICAID | 0150787 | 01 | WA | L & I WORKERS COMP | OTHER | 110227107 | 01 | WA | RAILROAD MEDICARE | OTHER | 2987LE | 01 | WA | REGENCE BLUESHIELD RIDER | OTHER |