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NPI Code Detail

MEDICARE: JONATHAN BUM LEE MD

MEDICARE: JONATHAN BUM LEE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PP0204XPediatric Emergency Medicine (Emergency Medicine) Physician1215356514VA
2208000000XPediatrics Physician1215356514VA
3390200000XStudent in an Organized Health Care Education/Training Program
42080P0204XPediatric Emergency Medicine (Pediatrics) Physician1215356514VA

General Provider Information

NPI Number : 1215356514
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN BUM LEE MD
Provider Business Mailing Address
First Line : 505 PORTER ST APT 807
Second Line :
City : RICHMOND
State : VA
Zip : 23224-2321
Country : US
Telephone Number : 703-868-3787
Fax Number :
Provider Business Practice Location Address
First Line : 7101 JAHNKE RD
Second Line :
City : RICHMOND
State : VA
Zip : 23225-4044
Country : US
Telephone Number : 954-977-9068
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2014
Last Update Date : 06/30/2021

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