Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS042485 | PA |
NPI | 1013549542 |
---|---|
Provider Name | Yun Jeong Lee |
First Address | Philadelphia, PA 19104-7722 |
Second Address | Fort Washington, PA 19034-2714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |