Provider Demographics
NPI:1144854225
Name:LEE, JONGHUN (MD)
Entity type:Individual
Prefix:MR
First Name:JONGHUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:75 FRANCIS STREET1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-732-7284
Mailing Address - Fax:978-352-9015
Practice Address - Street 1:75 FRANCIS STREET1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-7284
Practice Address - Fax:978-352-9015
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2021-03-23
Deactivation Date:2020-12-08
Deactivation Code:
Reactivation Date:2021-03-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program