MEDICARE: MR. JIMMY YUEN HING LEE RPAC

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	363A00000X	Physician Assistant	008875	NY

General Provider Information

NPI Number	:	1750328894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JIMMY YUEN HING LEE RPAC

Provider Business Mailing Address
First Line	:	359 HENDRICKSON AVE
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580
Country	:	US
Telephone Number	:	516-825-6438
Fax Number	:

Provider Business Practice Location Address
First Line	:	25-10 30TH AVE
Second Line	:	MOUNT SINAI HOSPITAL OF QUEENS
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11102-2495
Country	:	US
Telephone Number	:	631-267-4285
Fax Number	:	718-278-1766

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	03/04/2009

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