Provider Demographics
NPI:1306811955
Name:LEE, BENJAMIN YANCHUNG (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:YANCHUNG
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 1:669 REVOLUTION ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3319
Mailing Address - Country:US
Mailing Address - Phone:410-939-2840
Mailing Address - Fax:410-939-2329
Practice Address - Street 1:669 REVOLUTION ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3319
Practice Address - Country:US
Practice Address - Phone:410-939-2840
Practice Address - Fax:410-939-2329
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063981207R00000X
CAA84269207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI33492Medicare UPIN
MD276P582GMedicare ID - Type Unspecified