Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00326000 | NJ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 26NJ00326000 | NJ |
NPI | 1083904874 |
---|---|
Provider Name | Kyung Min Lee |
First Address | Pompton Plains, NJ 07444-1060 |
Second Address | Pompton Plains, NJ 07444-1060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2011 |
Last Update Date | 11/06/2014 |