Provider Demographics
NPI:1700082708
Name:LEE, MEE KYUNG (NP)
Entity Type:Individual
Prefix:
First Name:MEE KYUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 60TH STREET
Mailing Address - Street 2:ROOM 123
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220
Mailing Address - Country:US
Mailing Address - Phone:515-520-7150
Mailing Address - Fax:718-439-4006
Practice Address - Street 1:330 60TH ST
Practice Address - Street 2:RM123
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3720
Practice Address - Country:US
Practice Address - Phone:718-492-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381902363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics