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General NPI Number Information
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NPI Number | 1558446674
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Entity Type | Individual
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Provider Name | HYUN-SOO LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 14472 NORTHERN BLVD STE 203
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City | FLUSHING
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State | NY
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Zip | 11354-4231
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Country | US
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Telephone | 718-886-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 4012 80TH ST STE 5A
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City | ELMHURST
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State | NY
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Zip | 11373-1234
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Country | US
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Telephone | 718-886-9000
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Fax | 718-961-0666
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 186672
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 186672
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 186672
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MA66379
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License Number State | NJ
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