Provider Demographics
NPI:1003158759
Name:LEE, JENNIFER YANG (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:YANG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21116 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3241
Mailing Address - Country:US
Mailing Address - Phone:718-217-0500
Mailing Address - Fax:
Practice Address - Street 1:21116 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-3241
Practice Address - Country:US
Practice Address - Phone:718-217-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine