Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MA66379 | NJ |
N | 207ND0900X | Dermatopathologist | 186672 | NY |
N | 207NP0225X | Pediatric Dermatologist | 186672 | NY |
N | 207NS0135X | Procedural Dermatology | 186672 | NY |
NPI | 1558446674 |
---|---|
Provider Name | Hyun-Soo Lee |
First Address | Elmhurst, NY 11373-1234 |
Second Address | Flushing, NY 11354-4231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 14/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01761279 | (05) | NY |
7458703 | (05) | NJ |