Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | A143768 | CA |
Y | 2080P0201X | Pediatric Allergist | 290327 | MA |
NPI | 1255719597 |
---|---|
Provider Name | Dr. Ivan Lee |
First Address | Boston, MA 02115-5737 |
Second Address | Boston, MA 02115-5737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 24/01/2022 |