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General NPI Number Information
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NPI Number | 1326012154
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Entity Type | Individual
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Provider Name | JONATHAN K. LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 547 SHADOWBROOK CT
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City | REDLANDS
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State | CA
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Zip | 92374-6474
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Country | US
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Telephone | 909-645-1986
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Fax | 909-335-5767
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Provider Business Mailing Address
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Address Line | 547 SHADOWBROOK CT
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City | REDLANDS
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State | CA
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Zip | 92374-6474
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Country | US
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Telephone | 909-645-1986
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Fax | 909-335-5767
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | G69750
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | G69750
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License Number State | CA
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