Healthcare Provider Details

I. General information

NPI: 1184820425
Provider Name (Legal Business Name): ANN YEELIN LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

550 1ST AVE
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-3917
  • Fax:
Mailing address:
  • Phone: 212-562-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number253428
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: