Provider Demographics
NPI:1053555326
Name:HUR, JEE (MD)
Entity type:Individual
Prefix:
First Name:JEE
Middle Name:
Last Name:HUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-459-7415
Mailing Address - Fax:208-453-3307
Practice Address - Street 1:315 E ELM STREET
Practice Address - Street 2:STE 100
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605
Practice Address - Country:US
Practice Address - Phone:208-459-7415
Practice Address - Fax:208-453-3307
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-099251208000000X
IDM-12942208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH160730Medicare PIN
OH0073853Medicaid