MEDICARE: JAMES DONGMIN LEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205539160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DONGMIN LEE MD

Provider Business Mailing Address
First Line	:	125 PATERSON ST STE 7300
Second Line	:
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-1962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 PATERSON ST
Second Line	:	SUITE 7300
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-0890
Country	:	US
Telephone Number	:	732-235-8887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	03/22/2023

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