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General NPI Number Information
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NPI Number | 1821308743
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Entity Type | Individual
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Provider Name | MS. KYUNG JA LEE
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Gender | Female
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 808 BROOK AVE
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City | BRONX
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State | NY
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Zip | 10451
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Country | US
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Telephone | 718-665-2056
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Fax | 718-665-2725
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Provider Business Mailing Address
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Address Line | 75 MAIDEN LANE
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City | NYC
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State | NY
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Zip | 10038
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Country | US
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Telephone | 212-477-6100
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Fax | 212-405-2395
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 338487-1
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License Number State | NY
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