Provider Demographics
NPI:1275832586
Name:LEE, HEATHER EUNJOO (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:EUNJOO
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2216
Mailing Address - Country:US
Mailing Address - Phone:585-244-1000
Mailing Address - Fax:585-271-4786
Practice Address - Street 1:973 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2216
Practice Address - Country:US
Practice Address - Phone:585-244-1000
Practice Address - Fax:585-271-4786
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY283340207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program