Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 0116032141 | VA |
Y | 213ES0103X | Foot & Ankle Surgery | DP206474 | OR |
NPI | 1134692486 |
---|---|
Provider Name | Sean H Lee |
First Address | Portland, OR 97213-1443 |
Second Address | Gresham, OR 97030-3386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2019 |
Last Update Date | 05/08/2021 |