Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD00046382 | WA |
NPI | 1114965332 |
---|---|
Provider Name | Dr. Jason Kwang-Gu Lee |
First Address | Salt Lake City, UT 84125-0608 |
Second Address | Seattle, WA 98122-4396 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 24/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8452575 | (05) | WA |
H06109 | (02) | WA |