Active NPI
Kyung Jae Lee, PHARMD
- Pharmacist
- Meridian, ID
National Provider Identifier
1184304347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- P10652
- Practice address
- 4850 N Linder Rd
Meridian, ID 83646-6159 - Phone
- (208) 319-0047
- NPI assigned
- Jul 24, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P10652 | ID | Primary |
| Pharmacist | 183500000X | PH238571 | MA | |
| Pharmacist | 183500000X | PH61526496 | WA |
Addresses
Primary practice location
4850 N Linder Rd
Meridian, ID 83646-6159
Mailing address
4850 N Linder Rd
Meridian, ID 83646-6159
Phone (208) 319-0047
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P10652 | ID | MD | Pharmacist |
| PH238571 | MA | MD | Pharmacist |
| PH61526496 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
4850 N Linder Rd
Meridian, ID 83646
Phone (208) 319-0047
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717027200000",
"number": "1184304347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4850 N LINDER RD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836466159",
"telephone_number": "208-319-0047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4850 N LINDER RD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836466159",
"telephone_number": "208-319-0047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KYUNG JAE",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-07-24",
"last_updated": "2024-05-30",
"certification_date": "2024-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "P10652",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "PH238571",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61526496",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.