Provider Demographics
NPI:1083904874
Name:LEE, KYUNG MIN (NP-C)
Entity Type:Individual
Prefix:
First Name:KYUNG MIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KYUNG-MIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:230 W PARKWAY
Mailing Address - Street 2:#10
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1060
Mailing Address - Country:US
Mailing Address - Phone:973-835-0800
Mailing Address - Fax:
Practice Address - Street 1:230 W PARKWAY
Practice Address - Street 2:#10
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1060
Practice Address - Country:US
Practice Address - Phone:973-835-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00326000363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology