1154502045 NPI number — JOHN HYUNG-IL LEE M.D.

Table of content: JOHN HYUNG-IL LEE M.D. (NPI 1154502045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154502045 NPI number — JOHN HYUNG-IL LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
JOHN
Provider Middle Name:
HYUNG-IL
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:
1154502045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 YAWPO AVE
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07436-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-842-4000
Provider Business Mailing Address Fax Number:
601-261-3530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 YAWPO AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07436-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-337-0066
Provider Business Practice Location Address Fax Number:
201-337-7417
Provider Enumeration Date:
11/19/2007

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: 207RI0011X , with the licence number:  MD.202601 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 21970 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: MD2007018548 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 302I113087 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 9034318 . This is a "AETNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 3461517 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 9388251 . This is a "CIGNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1943312 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6057840 . This is a "HEALTHSPRING" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 05322806 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01109784 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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