Provider Demographics
NPI:1023070075
Name:LEE, MYUNG-HO (MD)
Entity type:Individual
Prefix:DR
First Name:MYUNG-HO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
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:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-0628
Mailing Address - Country:US
Mailing Address - Phone:914-593-7872
Mailing Address - Fax:914-593-7881
Practice Address - Street 1:16 RYE RIDGE PLZ
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2820
Practice Address - Country:US
Practice Address - Phone:914-593-7872
Practice Address - Fax:914-593-7881
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182644207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060043730OtherRR MEDICARE
NY01445216Medicaid
NY37J372Medicare PIN
CT060001666Medicare PIN
NY060043730OtherRR MEDICARE