Provider Demographics
NPI:1346213907
Name:LEE, STEPHEN YONG TAEK (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:YONG TAEK
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LAKE DR E STE 105
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1165
Mailing Address - Country:US
Mailing Address - Phone:856-809-4200
Mailing Address - Fax:856-306-5231
Practice Address - Street 1:220 LAKE DR E STE 105
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1165
Practice Address - Country:US
Practice Address - Phone:856-809-4200
Practice Address - Fax:856-306-5231
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052294L207W00000X
NJMA06655300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001518615-0001Medicaid
NJ6510906Medicaid
PA001518615-0002Medicaid
PA180031322Medicare PIN
PA001518615-0002Medicaid
NJ003606C9YMedicare PIN
NJ6510906Medicaid
NJ180031320Medicare PIN