Provider Demographics
NPI:1043762404
Name:JI MEDICAL GROUP PC
Entity Type:Organization
Organization Name:JI MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JUNHO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-353-4100
Mailing Address - Street 1:3825 PARSONS BLVD
Mailing Address - Street 2:STE 1G
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5837
Mailing Address - Country:US
Mailing Address - Phone:718-353-4100
Mailing Address - Fax:718-939-5500
Practice Address - Street 1:3825 PARSONS BLVD
Practice Address - Street 2:STE 1G
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5837
Practice Address - Country:US
Practice Address - Phone:718-353-4100
Practice Address - Fax:718-939-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166634207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty