Basic Information
Provider Information
NPI: 1780704544
EntityType: 2
ReplacementNPI:  
OrganizationName: UNMC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 983280 NEBRASKA MEDICAL CTR
Address2:  
City: OMAHA
State: NE
PostalCode: 681983280
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 983280 NEBRASKA MEDICAL CTR
Address2:  
City: OMAHA
State: NE
PostalCode: 681983280
CountryCode: US
TelephoneNumber: 4025597350
FaxNumber: 4025596749
Other Information
ProviderEnumerationDate: 03/29/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LEE
AuthorizedOfficialFirstName: YONG KWON
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: MIS FELLOW
AuthorizedOfficialTelephone: 4025597350
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X5534NEY HospitalsGeneral Acute Care Hospital 

No ID Information.


Home