Provider Demographics
NPI:1912135690
Name:LEE, DAVID YIM (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:YIM
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97458-1066
Mailing Address - Country:US
Mailing Address - Phone:541-572-2111
Mailing Address - Fax:541-572-5743
Practice Address - Street 1:324 4TH ST
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458-1066
Practice Address - Country:US
Practice Address - Phone:541-572-2111
Practice Address - Fax:541-572-5743
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157511207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherGROUP-NORTH BEND MEDICAL CENTER MEDICAID #
ORR0000WFBTVOtherGROUP-NORTH BEND MEDICAL CENTER MEDICARE #
OR500648523Medicaid
OR1407812365OtherGROUP-NORTH BEND MEDICAL CENTER NPI
OR93-0635514OtherGROUP-NORTH BEND MEDICAL CENTER TAX ID FOR BILLING
OR93-0635514OtherGROUP-NORTH BEND MEDICAL CENTER TAX ID FOR BILLING