Provider Demographics
NPI:1437253663
Name:LEE, JAMES C (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 REMITTANCE DR DEPT 6008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6008
Mailing Address - Country:US
Mailing Address - Phone:562-282-1419
Mailing Address - Fax:562-920-4642
Practice Address - Street 1:5475 E LA PALMA AVE
Practice Address - Street 2:STE 208
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-6009
Practice Address - Country:US
Practice Address - Phone:714-777-0750
Practice Address - Fax:714-777-8291
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213EG0000X213E00000X
CAE3963213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39630Medicaid
CAE3963EMedicare PIN
CAE3963GMedicare PIN
CA000E39630Medicaid