Provider Demographics
NPI:1871583096
Name:LEE, RICHARD JAEBONG (MD PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAEBONG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-4000
Mailing Address - Fax:617-643-1740
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 7E
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-4000
Practice Address - Fax:617-643-1740
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA219872207R00000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology