Basic Information
Provider Information
NPI: 1235461930
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: JI YOUNG
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 7987
Address2:  
City: MOBILE
State: AL
PostalCode: 36670
CountryCode: US
TelephoneNumber: 2516330573
FaxNumber: 2516337367
Practice Location
Address1: 6701 AIRPORT BLVD
Address2: SUITE B 135
City: MOBILE
State: AL
PostalCode: 366086705
CountryCode: US
TelephoneNumber: 2516330573
FaxNumber: 2516337367
Other Information
ProviderEnumerationDate: 02/04/2010
LastUpdateDate: 03/27/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RP1001X32475ALY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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