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General NPI Number Information
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NPI Number | 1629265327
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Entity Type | Organization
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Legal Business Name | BONG S LEE , M.D. PC
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 1810 RITTENHOUSE SQ THE SAVOY # B2
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5837
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Country | US
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Telephone | 215-545-0804
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 RITTENHOUSE SQ THE SAVOY # B2
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5837
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Country | US
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Telephone | 215-545-0804
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BONG S LEE
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Credential | M.D
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Telephone | 215-545-0804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD032195L
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License Number State | PA
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