Provider Demographics
NPI:1992013528
Name:LEE, YOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:YOHAN
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 1:651 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4938
Mailing Address - Country:US
Mailing Address - Phone:516-681-8822
Mailing Address - Fax:516-681-3332
Practice Address - Street 1:651 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4938
Practice Address - Country:US
Practice Address - Phone:516-681-8822
Practice Address - Fax:516-681-3332
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD453198208VP0014X, 208VP0000X, 2081P2900X, 208VP0014X
NJ25MA09579200208VP0014X, 208VP0000X, 2081P2900X, 208VP0000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA376037ZHBFMedicare PIN
FLHL567ZMedicare PIN
FLHL567YMedicare PIN
NJ377386YFRJMedicare PIN