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NPI Code Detail

MEDICARE: SOOK JA LEE MD

MEDICARE: SOOK JA LEE MD
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
1208000000XPediatrics Physician115228NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841250891
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOOK JA LEE MD
Provider Business Mailing Address
First Line : 1050 CLOVE RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10301-3627
Country : US
Telephone Number : 718-816-6440
Fax Number : 718-816-3611
Provider Business Practice Location Address
First Line : 4771 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6315
Country : US
Telephone Number : 718-948-8200
Fax Number : 718-816-3611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2006
Last Update Date : 07/08/2007

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Directions to “ SOOK JA LEE MD” Practice Location

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