Provider Demographics
NPI:1346241270
Name:LEE, JANGWOO (MD)
Entity Type:Individual
Prefix:
First Name:JANGWOO
Middle Name:
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 1:101 W MARKET AND CENTER ST
Mailing Address - Street 2:THOMPSON BLDG, STE 311
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901
Mailing Address - Country:US
Mailing Address - Phone:570-628-5625
Mailing Address - Fax:570-628-0393
Practice Address - Street 1:101 W MARKET AND CENTER ST
Practice Address - Street 2:THOMPSON BLDG, STE 311
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-628-5625
Practice Address - Fax:570-628-0393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033378L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15969OtherGEISINGER
PA0006087630001Medicaid
PA02337000OtherBLUE CROSS
C30882Medicare UPIN