Provider Demographics
NPI:1326012154
Name:LEE, JONATHAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:547 SHADOWBROOK CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6474
Mailing Address - Country:US
Mailing Address - Phone:909-645-1986
Mailing Address - Fax:909-335-5767
Practice Address - Street 1:547 SHADOWBROOK CT
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-6474
Practice Address - Country:US
Practice Address - Phone:909-645-1986
Practice Address - Fax:909-335-5767
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69750208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF79938Medicare UPIN