Provider Demographics
NPI:1073653648
Name:LEE, DAE YOUN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAE YOUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2866 209TH PL
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2425
Mailing Address - Country:US
Mailing Address - Phone:718-225-6968
Mailing Address - Fax:718-282-3840
Practice Address - Street 1:3016 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4210
Practice Address - Country:US
Practice Address - Phone:718-282-4615
Practice Address - Fax:718-282-3840
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist