Basic Information
Provider Information
NPI: 1578943171
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: YOOMIE
MiddleName: JANE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7800 SW 87TH AVE STE C-340
Address2:  
City: MIAMI
State: FL
PostalCode: 331733570
CountryCode: US
TelephoneNumber: 3055950109
FaxNumber: 3055957092
Practice Location
Address1: 7411 MIAMI LAKES DR
Address2:  
City: MIAMI LAKES
State: FL
PostalCode: 33014
CountryCode: US
TelephoneNumber: 3058231369
FaxNumber: 3058198117
Other Information
ProviderEnumerationDate: 06/09/2015
LastUpdateDate: 09/23/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207KA0200XME141487FLY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy

No ID Information.


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