Provider Demographics
NPI:1235674458
Name:LEE, MOON JEONG (MD)
Entity type:Individual
Prefix:
First Name:MOON JEONG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:840 WALNUT ST STE 1230
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-440-3160
Mailing Address - Fax:215-928-3465
Practice Address - Street 1:840 WALNUT ST STE 1110
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3197
Practice Address - Fax:215-928-0166
Is Sole Proprietor?:No
Enumeration Date:2016-12-24
Last Update Date:2024-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD484290207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist