Provider Demographics
NPI:1376784447
Name:LEE, EDWARD SANG JOON (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SANG JOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:757 WESTWOOD PLZ
Mailing Address - Street 2:SUITE 7501Q
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8358
Mailing Address - Country:US
Mailing Address - Phone:310-825-8041
Mailing Address - Fax:310-267-3840
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:7501Q
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8358
Practice Address - Country:US
Practice Address - Phone:310-267-9643
Practice Address - Fax:310-267-3840
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2017-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA107027208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376784447Medicaid
CADO000ZMedicare PIN