Provider Demographics
NPI:1518156108
Name:LEE, JUNG HWAN (AUD)
Entity Type:Individual
Prefix:
First Name:JUNG HWAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 CHESTNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4634
Mailing Address - Country:US
Mailing Address - Phone:215-561-0550
Mailing Address - Fax:215-561-1235
Practice Address - Street 1:1920 CHESTNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4634
Practice Address - Country:US
Practice Address - Phone:215-561-0550
Practice Address - Fax:215-561-1235
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006038237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter