Provider Demographics
NPI:1184644924
Name:WAI S. LEE MD, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WAI S. LEE MD, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WAI
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-432-8300
Mailing Address - Street 1:540 E HERNDON AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2907
Mailing Address - Country:US
Mailing Address - Phone:559-432-8300
Mailing Address - Fax:559-432-9083
Practice Address - Street 1:540 E HERNDON AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2907
Practice Address - Country:US
Practice Address - Phone:559-432-8300
Practice Address - Fax:559-432-9083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOOG552110208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01533ZMedicare ID - Type Unspecified