Provider Demographics
NPI:1740228519
Name:LEE, HWASUN (MD)
Entity Type:Individual
Prefix:
First Name:HWASUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:88-31 55TH AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4686
Practice Address - Country:US
Practice Address - Phone:718-899-6600
Practice Address - Fax:718-397-7782
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY121609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00947879Medicaid
NY00947879Medicaid
NYC66879Medicare UPIN