Provider Demographics
NPI:1538727946
Name:LEE, JOSHUA KISOO (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:KISOO
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 1:777 TOWNSHIP LINE RD.
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5564
Mailing Address - Country:US
Mailing Address - Phone:215-860-0775
Mailing Address - Fax:215-860-7754
Practice Address - Street 1:777 TOWNSHIP LINE RD.
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5564
Practice Address - Country:US
Practice Address - Phone:215-860-0775
Practice Address - Fax:215-860-7754
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD478053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine