Provider Demographics
NPI:1558563767
Name:JUNG H. LEE, INC
Entity Type:Organization
Organization Name:JUNG H. LEE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-937-0817
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-0309
Mailing Address - Country:US
Mailing Address - Phone:636-937-0817
Mailing Address - Fax:636-937-8818
Practice Address - Street 1:170 INDUSTRIAL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4106
Practice Address - Country:US
Practice Address - Phone:636-937-0817
Practice Address - Fax:636-937-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8562207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200016202Medicaid
MO000005285Medicare PIN
MOA11492Medicare UPIN