Provider Demographics
NPI:1942260849
Name:LEE, JUNG H (DPM)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5526
Mailing Address - Country:US
Mailing Address - Phone:610-865-0311
Mailing Address - Fax:610-865-9458
Practice Address - Street 1:303 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5526
Practice Address - Country:US
Practice Address - Phone:610-865-0311
Practice Address - Fax:610-865-9458
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005726213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015634170001Medicaid
PA1015634170001Medicaid