Provider Demographics
NPI:1831713221
Name:LEE, DONGYUP
Entity type:Individual
Prefix:
First Name:DONGYUP
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-9728
Mailing Address - Country:US
Mailing Address - Phone:308-675-3222
Mailing Address - Fax:308-675-3234
Practice Address - Street 1:403 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-9728
Practice Address - Country:US
Practice Address - Phone:308-675-3222
Practice Address - Fax:308-675-3234
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE368092081P2900X
IL036168666207LP2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program