Basic Information
Provider Information
NPI: 1245486836
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: EARN CHUN
MiddleName: CHRISTABEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 418283
Address2:  
City: BOSTON
State: MA
PostalCode: 022418283
CountryCode: US
TelephoneNumber: 7035581544
FaxNumber:  
Practice Location
Address1: 3800 RESERVOIR RD NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200072113
CountryCode: US
TelephoneNumber: 2024443450
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/14/2008
LastUpdateDate: 03/08/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
2085N0700XMD039626DCY Allopathic & Osteopathic PhysiciansRadiologyNeuroradiology

No ID Information.


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