Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 302623 | NY |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 302623 | NY |
NPI | 1063938611 |
---|---|
Provider Name | Wonyong Lee |
First Address | Sayre, PA 18840-1625 |
Second Address | Horseheads, NY 14845-1403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 06/03/2021 |