Provider Demographics
NPI:1497776348
Name:JUNG S LEE MD, PC
Entity Type:Organization
Organization Name:JUNG S LEE MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-678-3007
Mailing Address - Street 1:320 ABINGTON DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1898
Mailing Address - Country:US
Mailing Address - Phone:610-678-3007
Mailing Address - Fax:610-678-9845
Practice Address - Street 1:320 ABINGTON DR
Practice Address - Street 2:SUITE #1
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1898
Practice Address - Country:US
Practice Address - Phone:610-678-3007
Practice Address - Fax:610-678-9845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037840L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068267OtherMEDICARE GROUP ID NUMBER
PA0006542100007Medicaid
PAC31701Medicare UPIN