Provider Demographics
NPI:1629565064
Name:LEE, GUANG YU (DO)
Entity Type:Individual
Prefix:
First Name:GUANG YU
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1120
Mailing Address - Country:US
Mailing Address - Phone:718-470-7550
Mailing Address - Fax:516-396-4744
Practice Address - Street 1:444 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1120
Practice Address - Country:US
Practice Address - Phone:718-470-7550
Practice Address - Fax:516-396-4744
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310335207Y00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine