Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 1215356514 | VA |
N | 208000000X | Pediatrician | 1215356514 | VA |
Y | 2080P0204X | Pediatric Emergency Doctor | 1215356514 | VA |
NPI | 1215356514 |
---|---|
Provider Name | Jonathan Bum Lee |
First Address | Richmond, VA 23224-2321 |
Second Address | Richmond, VA 23225-4044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 30/06/2021 |