Provider Demographics
NPI:1134721046
Name:LEE, ERIC JONATHAN ONG
Entity type:Individual
Prefix:
First Name:ERIC JONATHAN
Middle Name:ONG
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1430
Mailing Address - Country:US
Mailing Address - Phone:818-795-5938
Mailing Address - Fax:
Practice Address - Street 1:611 N BRAND BLVD # 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1221
Practice Address - Country:US
Practice Address - Phone:747-286-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst