Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD61134383 | WA |
N | 208600000X | Surgeon | MD61134383 | WA |
Y | 2086S0127X | Trauma Surgeon | MD61134383 | WA |
NPI | 1184967150 |
---|---|
Provider Name | Dr. Jae Won Lee |
First Address | Richland, WA 99352 |
Second Address | Richland, WA 99352-3514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2013 |
Last Update Date | 21/09/2021 |