Healthcare Provider Details

I. General information

NPI: 1295479210
Provider Name (Legal Business Name): JOONKYUNG LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LENA LEE MD

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 2ND AVE
BROOKLYN NY
11220
US

IV. Provider business mailing address

5500 2ND AVE
BROOKLYN NY
11220
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number343898
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number343898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: