Provider Demographics
NPI:1366657207
Name:LEE, REGINA CHIWON (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:CHIWON
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 EAST 68TH STREET,
Mailing Address - Street 2:ST-5, BOX 331
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-746-1144
Mailing Address - Fax:212-746-1014
Practice Address - Street 1:156 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:646-962-5665
Practice Address - Fax:646-962-5687
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436750207R00000X
PAMT188191207R00000X
NY253031-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine