Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | D9128 | OR |
Y | 213EG0000X | General Practice | D9128 | OR |
NPI | 1003095225 |
---|---|
Provider Name | Esther Jihae Lee |
First Address | Beaverton, OR 97006-5254 |
Second Address | Beaverton, OR 97006-5254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 19/04/2016 |