Provider Demographics
NPI:1730210949
Name:LEE, HUNG-SAM
Entity type:Individual
Prefix:
First Name:HUNG-SAM
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 UNION ST STE 7B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5672
Mailing Address - Country:US
Mailing Address - Phone:718-762-1888
Mailing Address - Fax:718-762-1889
Practice Address - Street 1:3808 UNION ST STE 7B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5672
Practice Address - Country:US
Practice Address - Phone:718-762-1888
Practice Address - Fax:718-762-1889
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease