Provider Demographics
NPI:1225217292
Name:JOHN A LEE MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOHN A LEE MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-817-9832
Mailing Address - Street 1:1250 LA VENTA DR STE 207
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3766
Mailing Address - Country:US
Mailing Address - Phone:805-497-9484
Mailing Address - Fax:805-495-2572
Practice Address - Street 1:1250 LA VENTA DR STE 207
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3766
Practice Address - Country:US
Practice Address - Phone:805-497-9484
Practice Address - Fax:805-495-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G1218100Medicaid
CAG12181Medicare PIN
CAA38577Medicare UPIN