Provider Demographics
NPI:1669574984
Name:LEE, YONG DAE (RPH)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:DAE
Last Name:LEE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4734
Mailing Address - Country:US
Mailing Address - Phone:718-863-0203
Mailing Address - Fax:718-863-0940
Practice Address - Street 1:2197 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4734
Practice Address - Country:US
Practice Address - Phone:718-863-0203
Practice Address - Fax:718-863-0940
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist