Provider Demographics
NPI:1568777613
Name:LEE, HYUNJAE (DPM, DC)
Entity Type:Individual
Prefix:DR
First Name:HYUNJAE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 55TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4514
Mailing Address - Country:US
Mailing Address - Phone:551-257-8394
Mailing Address - Fax:
Practice Address - Street 1:150 E 55TH ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4514
Practice Address - Country:US
Practice Address - Phone:551-257-8394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012429111N00000X
CA5707213E00000X
NY007121213E00000X
NY39020000X213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No111N00000XChiropractic ProvidersChiropractor