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General NPI Number Information
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NPI Number | 1447773296
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Entity Type | Individual
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Provider Name | JACOB CHUNG LEE MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 07/24/2017
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Provider Practice Location Address
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Address Line | 6329 GALL BLVD
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-2515
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Country | US
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Telephone | 813-788-7616
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Fax |
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Provider Business Mailing Address
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Address Line | 119 IVY LN
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City | TENAFLY
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State | NJ
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Zip | 07670-2410
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Country | US
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Telephone |
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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 | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | ME132877
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME132877
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License Number State | FL
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