Provider Demographics
NPI:1972566198
Name:LEE, OOK JAI (MD)
Entity type:Individual
Prefix:DR
First Name:OOK
Middle Name:JAI
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 1:960 BEAVER GRADE RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2718
Mailing Address - Country:US
Mailing Address - Phone:412-264-4741
Mailing Address - Fax:412-269-1417
Practice Address - Street 1:960 BEAVER GRADE RD
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2718
Practice Address - Country:US
Practice Address - Phone:412-264-4741
Practice Address - Fax:412-269-1417
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034775L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC32725Medicare UPIN