Provider Demographics
NPI:1932983236
Name:LEE, JOHN YANG (MD)
Entity Type:Individual
Prefix:
First Name:JOHN YANG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JIAN
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:88 BAY 34TH ST # 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5208
Mailing Address - Country:US
Mailing Address - Phone:929-867-4872
Mailing Address - Fax:
Practice Address - Street 1:837 59TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5576
Practice Address - Country:US
Practice Address - Phone:718-680-8881
Practice Address - Fax:718-680-7880
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty