Provider Demographics
NPI:1861417289
Name:LEE, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-0700
Mailing Address - Country:US
Mailing Address - Phone:801-376-9797
Mailing Address - Fax:801-785-9263
Practice Address - Street 1:278 S 100 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2622
Practice Address - Country:US
Practice Address - Phone:801-376-9797
Practice Address - Fax:801-785-9263
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT30528335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870523363007Medicaid