Provider Demographics
NPI:1649571944
Name:LEE, JEONG BUM (LMP)
Entity Type:Individual
Prefix:MR
First Name:JEONG
Middle Name:BUM
Last Name:LEE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28210 51ST PL S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-1932
Mailing Address - Country:US
Mailing Address - Phone:206-856-3731
Mailing Address - Fax:
Practice Address - Street 1:1048 W JAMES ST STE 104
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4600
Practice Address - Country:US
Practice Address - Phone:253-850-2800
Practice Address - Fax:253-850-2805
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60190442174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist