Individual
JOHNATHAN CHUNGTAE LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13942 NE GLISAN ST, PORTLAND, OR 97230-3350
(971) 302-7990
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/21/2013
Last updated
05/21/2013
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