Provider Demographics
NPI:1790814390
Name:HAN SHIK LEE MD PC
Entity Type:Organization
Organization Name:HAN SHIK LEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:SHIK
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-224-1600
Mailing Address - Street 1:14021 32ND AVE
Mailing Address - Street 2:SUITE C1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2613
Mailing Address - Country:US
Mailing Address - Phone:718-224-1600
Mailing Address - Fax:718-224-8085
Practice Address - Street 1:14021 32ND AVE
Practice Address - Street 2:SUITE C1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2613
Practice Address - Country:US
Practice Address - Phone:718-224-1600
Practice Address - Fax:718-224-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03418384Medicaid
NY6683160001OtherSUPPLIER MEDICARE DME
NYF31117Medicare UPIN
NY06918Medicare ID - Type Unspecified