Provider Demographics
NPI:1154504074
Name:JOHN C LEE, MD INC
Entity Type:Organization
Organization Name:JOHN C LEE, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-282-6989
Mailing Address - Street 1:207 S SANTA ANITA AVE
Mailing Address - Street 2:SUITE G18
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1146
Mailing Address - Country:US
Mailing Address - Phone:626-282-6989
Mailing Address - Fax:626-282-7389
Practice Address - Street 1:207 S SANTA ANITA AVE
Practice Address - Street 2:SUITE G18
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1146
Practice Address - Country:US
Practice Address - Phone:626-282-6989
Practice Address - Fax:626-282-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty