1417931494 NPI number — JUNG HI LEE M.D.

Table of content: JUNG HI LEE M.D. (NPI 1417931494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417931494 NPI number — JUNG HI LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
JUNG HI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417931494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MADISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENNINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08534-4221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-730-0218
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STUYVESANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-777-1996
Provider Business Practice Location Address Fax Number:
609-633-1312
Provider Enumeration Date:
12/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084F0202X , with the licence number:  34114 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0541605 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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