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General NPI Number Information
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NPI Number | 1699940692
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Entity Type | Individual
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Provider Name | EDWARD JUNG KYUN LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 51 ROUTE 23 SOUTH
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City | RIVERDALE
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State | NJ
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Zip | 07457
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Country | US
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Telephone | 973-831-1220
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Fax | 973-831-0029
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone | 908-277-8673
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 52768
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 25MA12108100
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License Number State | NJ
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