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General NPI Number Information
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NPI Number | 1851474118
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Entity Type | Individual
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Provider Name | JEHYUK LEE MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2601 HOLME AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2007
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Country | US
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Telephone | 215-335-6627
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Fax |
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Provider Business Mailing Address
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Address Line | 364 RIVERWAY APT 1
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City | BOSTON
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State | MA
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Zip | 02115-6419
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | MD427014
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License Number State | PA
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