MEDICARE: KYUNGME LEE

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	163W00000X	Registered Nurse	638565	NY

General Provider Information

NPI Number	:	1336688027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYUNGME LEE

Provider Business Mailing Address
First Line	:	3420 43RD ST
Second Line	:	APT 2R
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1470
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 43RD ST
Second Line	:	APT 2R
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1470
Country	:	US
Telephone Number	:	917-868-5664
Fax Number	:

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

Provider Enumeration Date	:	02/15/2017
Last Update Date	:	02/15/2017

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Directions to “ KYUNGME LEE ” Practice Location

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