Active NPI
Shin Jae Lee, M.D.
- Psychiatry Physician
- Warren, OH
National Provider Identifier
1932110319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 35039468L
- Practice address
- 1400 Tod Ave NW
Warren, OH 44485-2483 - Phone
- (330) 392-0311
- NPI assigned
- Aug 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 35039468L | OH | Primary |
Addresses
Primary practice location
1400 Tod Ave NW
Warren, OH 44485-2483
Mailing address
30 E Juniper LN
Moreland Hills, OH 44022-1376
Phone (440) 247-9520
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35039468L | OH | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Veterans Health Administration | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- VA Clinic/Center
- Warren, OH
- NPI 1174617468
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932110319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30 E JUNIPER LN",
"city": "MORELAND HILLS",
"state": "OH",
"postal_code": "440221376",
"telephone_number": "440-247-9520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 TOD AVE NW",
"city": "WARREN",
"state": "OH",
"postal_code": "444852483",
"telephone_number": "330-392-0311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SHIN",
"middle_name": "JAE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OH",
"license": "35039468L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Warren, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.