Provider Demographics
NPI:1093733156
Name:LEE, JUNG S (MD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:300 FAIRVIEW AVE
Mailing Address - Street 2:WESTWOOD OPHTHALMOLOGY
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1749
Mailing Address - Country:US
Mailing Address - Phone:201-666-4104
Mailing Address - Fax:201-666-4754
Practice Address - Street 1:300 FAIRVIEW AVE
Practice Address - Street 2:WESTWOOD OPHTHALMOLOGY
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-4104
Practice Address - Fax:201-666-4754
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD64728207W00000X
NJ25MA07620500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH96351Medicare UPIN