Provider Demographics
NPI:1164451753
Name:LEE, DANIEL WONIL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WONIL
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 1:111 FOUNDERS PLAZA
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108
Mailing Address - Country:US
Mailing Address - Phone:860-289-3375
Mailing Address - Fax:
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-847-6049
Practice Address - Fax:818-847-4842
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA688372085R0202X
DCMD0369422085N0700X
VA01012579822085N0700X
MA2656002085N0700X
MDD00772372085N0700X
TXP15602085N0700X
CT0547642085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCP00616353OtherRAILROAD MEDICARE
CA00A688370Medicaid
DCP00616353OtherRAILROAD MEDICARE
CAH69571Medicare UPIN
CAWA82022EMedicare PIN
DC003162M65Medicare PIN
CA00A688370Medicaid