Provider Demographics
NPI:1013025915
Name:LEE, YONG LIE (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:LIE
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 PULLMAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5713
Mailing Address - Country:US
Mailing Address - Phone:949-222-0670
Mailing Address - Fax:
Practice Address - Street 1:888 TIANLIN LU, BUILDING 1E,
Practice Address - Street 2:
Practice Address - City:SHANGHAI
Practice Address - State:LUWAN
Practice Address - Zip Code:200233
Practice Address - Country:CN
Practice Address - Phone:86216-464-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70394FOtherMEDI CAL
W5740BMedicare ID - Type Unspecified
CAFHC70394FOtherMEDI CAL