Active NPI
Kwang Hae Lee, MD
- Pediatrics Physician
- Far Rockaway, NY
National Provider Identifier
1003995531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 111384
- Practice address
- 18-47C Mott Avenue
Far Rockaway, NY 11691 - Phone
- (718) 868-8282
- Fax
- (718) 471-2865
- NPI assigned
- Nov 3, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 111384 | NY | Primary |
Addresses
Primary practice location
18-47C Mott Avenue
Far Rockaway, NY 11691
Mailing address
76 Halyard Rd
Valley Stream, NY 11581-2813
Phone (516) 791-3521
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00200239 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111384 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003995531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "76 HALYARD RD",
"city": "VALLEY STREAM",
"state": "NY",
"postal_code": "115812813",
"telephone_number": "516-791-3521",
"fax_number": "718-471-2865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18-47C MOTT AVENUE",
"city": "FAR ROCKAWAY",
"state": "NY",
"postal_code": "11691",
"telephone_number": "718-868-8282",
"fax_number": "718-471-2865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KWANG",
"middle_name": "HAE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "111384",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00200239",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Far Rockaway, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.