Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | G69750 | CA |
Y | 2081P2900X | Pain Medicine | G69750 | CA |
NPI | 1326012154 |
---|---|
Provider Name | Dr. Jonathan K. Lee |
First Address | Redlands, CA 92374-6474 |
Second Address | Redlands, CA 92374-6474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 29/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F79938 | (02) | CA |