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Organization

HANS LEE MD INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THEODORE A JACKSON M. D. (PRESIDENT)
(304) 342-1113
Entity
Organization

Contact information

Practice address
1306 KANAWHA BLVD E, SUITE 100, CHARLESTON, WV 25301-3001
(304) 342-1113
(304) 346-2271
Mailing address
1306 KANAWHA BLVD E, SUITE 100, CHARLESTON, WV 25301-3001
(304) 342-1113
(304) 346-2271

Taxonomy

Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0114231002
WV
Enumeration date
08/31/2005
Last updated
11/20/2024
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