Healthcare Provider Details

I. General information

NPI: 1912145798
Provider Name (Legal Business Name): TIEN CARDIOLOGY ASSOCIATE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2009
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 UNION ST STE 7B
FLUSHING NY
11354-5672
US

IV. Provider business mailing address

3808 UNION ST STE 7B
FLUSHING NY
11354-5672
US

V. Phone/Fax

Practice location:
  • Phone: 718-762-1888
  • Fax: 718-762-1889
Mailing address:
  • Phone: 718-762-1888
  • Fax: 718-762-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number198797
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number198797
License Number StateNY

VIII. Authorized Official

Name: DR. HUNG-SAM LEE
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 917-623-2028