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NPI Code Detail

MEDICARE: BONG S LEE , M.D. PC

MEDICARE: BONG S LEE , M.D. PC
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
1174400000XSpecialistMD032195LPA

General Provider Information

NPI Number : 1629265327
Entity Type Code : Organization
Provider Name (Legal Business Name) : BONG S LEE , M.D. PC
Provider Business Mailing Address
First Line : 1810 RITTENHOUSE SQ
Second Line : THE SAVOY # B2
City : PHILADELPHIA
State : PA
Zip : 19103-5837
Country : US
Telephone Number : 215-545-0804
Fax Number :
Provider Business Practice Location Address
First Line : 1810 RITTENHOUSE SQ
Second Line : THE SAVOY # B2
City : PHILADELPHIA
State : PA
Zip : 19103-5837
Country : US
Telephone Number : 215-545-0804
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : BONG S LEE
Credential : M.D
Telephone Number : 215-545-0804
Provider Enumeration Date : 09/27/2007
Last Update Date : 12/18/2007

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