Provider Demographics
NPI:1083717391
Name:LEE, HWE-SEUNG LUCY WHANG (MD)
Entity Type:Individual
Prefix:
First Name:HWE-SEUNG
Middle Name:LUCY WHANG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HWE-SEUNG
Other - Middle Name:LUCY
Other - Last Name:WHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18406 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-885-8500
Mailing Address - Fax:818-727-0793
Practice Address - Street 1:18406 ROSCOE BLVD
Practice Address - Street 2:NORTHRIDGE FAMILY PRACTICE MEDICAL GROUP INC
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-885-8500
Practice Address - Fax:818-727-0793
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A682050Medicaid
H53648Medicare UPIN
CAWA68205AMedicare PIN