Provider Demographics
NPI:1669011201
Name:LEE, HO RIM (NDTR)
Entity Type:Individual
Prefix:MS
First Name:HO
Middle Name:RIM
Last Name:LEE
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4338
Mailing Address - Country:US
Mailing Address - Phone:610-457-2409
Mailing Address - Fax:
Practice Address - Street 1:1447 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:PA
Practice Address - Zip Code:19061-4338
Practice Address - Country:US
Practice Address - Phone:610-457-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA86172410136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered