| NPI | 1336343268 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HYUN SOO LEE Owner 718-886-9000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 017273) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 270019) |
| 207N00000X Dermatology (Licence: NY 191741) | |
| 207ND0900X Dermatology Dermatopathology (Licence: NY 186672) | |
| 207ND0900X Dermatology Dermatopathology (Licence: NY 258414) | |
| 363A00000X Physician Assistant (Licence: NY 012705) | |
| 363A00000X Physician Assistant (Licence: NY 012529) | |
| 363A00000X Physician Assistant (Licence: NY 015855) | |
| 363A00000X Physician Assistant (Licence: NY 017384) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2020-08-21 |