MEDICARE: DR. HYUNJAE LEE DPM, DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X012429	NY
2	213E00000X	Podiatrist	5707	CA
3	213E00000X	Podiatrist	007121	NY

General Provider Information

NPI Number	:	1568777613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUNJAE LEE DPM, DC

Provider Business Mailing Address
First Line	:	150 E 55TH ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4514
Country	:	US
Telephone Number	:	551-257-8394
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 E 55TH ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-4514
Country	:	US
Telephone Number	:	551-257-8394
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	12/09/2020

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