Individual provider · Type 1 NPI

Jisoo Lee, MD

Student in an Organized Health Care Education/Training Program · Staten Island, NY

NPI number 1174456743 Active

Practice location

355 Bard Avenue, Department Of Medicine, Villa Bldg 1st
Staten Island, NY 10310

Call (718) 818-2419 Map

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1174456743

Jisoo Lee, MD's National Provider Identifier is 1174456743, issued on Jun 4, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Staten Island, NY. The record was last updated on Jun 4, 2026.