Provider Demographics
NPI:1023718798
Name:LEE, JONATHAN DONGIK
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DONGIK
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HURLEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-2131
Mailing Address - Country:US
Mailing Address - Phone:857-505-8095
Mailing Address - Fax:
Practice Address - Street 1:210 HURLEY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-2131
Practice Address - Country:US
Practice Address - Phone:857-505-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program