Provider Demographics
NPI:1154502045
Name:LEE, JOHN HYUNG-IL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HYUNG-IL
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 1:43 YAWPO AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-2717
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:601-261-3530
Practice Address - Street 1:43 YAWPO AVE
Practice Address - Street 2:STE 2
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-2717
Practice Address - Country:US
Practice Address - Phone:201-337-0066
Practice Address - Fax:201-337-7417
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202601207RI0011X
MS21970207RC0000X
MOMD2007018548207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS302I113087OtherMEDICARE PTAN
MS9034318OtherAETNA
MS3461517OtherUNITED HEALTHCARE
MS9388251OtherCIGNA
LA1943312Medicaid
MS6057840OtherHEALTHSPRING
MS05322806Medicaid
MSP01109784OtherRAILROAD MEDICARE
LA289589YH3UMedicare PIN