Individual
BONMYONG LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 SPRUCE STREET, PHILADELPHIA, PA 19104-4206
(215) 662-3000
(215) 662-7011
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-3000
(215) 662-7011
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD478423
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131
CAREFIRST
—
05
—
1093923047
—
VA
05
—
289604ZARD
—
DC
01
—
328550
KAISER
—
05
—
3810025992
—
WV
01
—
540846558
MULTIPLAN - PHCS NETWORK ONLY
—
01
—
75759
AMERIGROUP
VA
Enumeration date
05/21/2007
Last updated
09/15/2025
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