Provider Demographics
NPI:1629265657
Name:LEE, EDWARD SANG KEUN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SANG KEUN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:140 BERGEN ST STE E1620
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2425
Mailing Address - Country:US
Mailing Address - Phone:973-972-5377
Mailing Address - Fax:973-972-8268
Practice Address - Street 1:140 BERGEN ST STE E1620
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-5377
Practice Address - Fax:973-972-8268
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249420-1208200000X
NJ25MA084098002086S0122X
PAMD435100208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery