Basic Information
| Provider Information | |||||||||
| NPI: | 1538727946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | KISOO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 TOWNSHIP LINE RD. | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190675564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158600775 | ||||||||
| FaxNumber: | 2158607754 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 TOWNSHIP LINE RD. | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190675564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158600775 | ||||||||
| FaxNumber: | 2158607754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2019 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD478053 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.