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General NPI Number Information
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NPI Number | 1003163007
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Entity Type | Individual
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Provider Name | JAMES HYUN SOO LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | CVN 76 USS RONALD REAGAN
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City | BREMERTON
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State | WA
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Zip | 98310
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Country | US
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Telephone | 610-304-4921
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 WASHINGTON ST APARTMENT 1A
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City | HOBOKEN
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State | NJ
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Zip | 07030-5382
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Country | US
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Telephone | 610-304-4921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD446455
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License Number State | PA
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