Healthcare Provider Details

I. General information

NPI: 1083540389
Provider Name (Legal Business Name): HYUNSEUNG LEE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

IV. Provider business mailing address

9 PLEASANT ST APT B
VERNON ROCKVILLE CT
06066-3347
US

V. Phone/Fax

Practice location:
  • Phone: 718-215-1818
  • Fax:
Mailing address:
  • Phone: 609-349-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberN13246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: