Provider Demographics
NPI:1962376616
Name:LEE, JONGSOO (MD)
Entity type:Individual
Prefix:
First Name:JONGSOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:JONGSOO
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9115 S TACOMA WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4400
Mailing Address - Country:US
Mailing Address - Phone:253-581-4564
Mailing Address - Fax:253-581-6484
Practice Address - Street 1:9115 S TACOMA WAY STE 105
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4400
Practice Address - Country:US
Practice Address - Phone:253-581-4564
Practice Address - Fax:253-581-6484
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.70039970207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology