Provider Demographics
NPI:1518154889
Name:LEE, ANDREW DONGJUN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DONGJUN
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 1:690 PARKWOOD MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2487
Mailing Address - Country:US
Mailing Address - Phone:336-835-0165
Mailing Address - Fax:336-835-0170
Practice Address - Street 1:690 PARKWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2487
Practice Address - Country:US
Practice Address - Phone:336-835-0165
Practice Address - Fax:336-835-0170
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00295207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914927Medicaid
2076444Medicare UPIN