Individual
MR. BONG SHIK LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
34TH & CIVIC CENTER BLVD, THE CHILDREN'S HOSPITAL OF PHILADELPHIA, PHILADELPHIA, PA 19104-4306
(215) 590-1527
(215) 590-1501
Mailing address
100 EAST PENN SQUARE, THE WANAMAKER BUILDING 9TH FL, PHILADELPHIA, PA 19107-3323
(267) 425-9538
(267) 425-9552
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD-032195-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0052378000
KEYSTONE PERSONAL CHOICE
—
01
—
31825
AETNA
—
Enumeration date
07/25/2006
Last updated
04/11/2013
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