Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01073770A | IN |
Y | 111NI0900X | Internist | 01073770A | IN |
NPI | 1003107517 |
---|---|
Provider Name | Dr. Joseph Tien-Yo Lee |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Avon, IN 46123-6911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2011 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201094410 | (05) | IN |