Provider Demographics
NPI:1366671836
Name:LEE, HO JE (MD)
Entity Type:Individual
Prefix:
First Name:HO JE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:966 S WESTERN AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1015
Mailing Address - Country:US
Mailing Address - Phone:323-452-0656
Mailing Address - Fax:562-443-3791
Practice Address - Street 1:966 S WESTERN AVE
Practice Address - Street 2:STE 201
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1015
Practice Address - Country:US
Practice Address - Phone:323-452-0656
Practice Address - Fax:562-443-3791
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2020-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA112040207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEZ195XMedicare UPIN