Provider Demographics
NPI:1285616409
Name:LEE, JIN OK (MD)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:OK
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4845 S RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4750
Mailing Address - Country:US
Mailing Address - Phone:702-362-9800
Mailing Address - Fax:702-871-9805
Practice Address - Street 1:4845 S RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4916
Practice Address - Country:US
Practice Address - Phone:702-362-9800
Practice Address - Fax:702-871-9805
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100405Medicare ID - Type UnspecifiedINDIVIDUAL
NV36674Medicare ID - Type UnspecifiedGROUP
NVH02646Medicare UPIN