Active NPI
Jae Ki Lee
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Fort Worth, TX
National Provider Identifier
1528667961
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 57496
- Practice address
- 6650 N Beach St
Fort Worth, TX 76137-1801 - Phone
- (817) 788-1757
- NPI assigned
- Oct 17, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 57496 | TX | Primary |
Addresses
Primary practice location
6650 N Beach St
Fort Worth, TX 76137-1801
Mailing address
6650 N Beach St
Fort Worth, TX 76137-1801
Phone (817) 788-1688
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57496 | TX | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602892800000",
"number": "1528667961",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6650 N BEACH ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761371801",
"telephone_number": "817-788-1688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6650 N BEACH ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761371801",
"telephone_number": "817-788-1757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JAE KI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-17",
"last_updated": "2020-10-17",
"certification_date": "2020-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "TX",
"license": "57496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.