Provider Demographics
NPI:1467449009
Name:LEE, YUSHEN WANG (MD)
Entity Type:Individual
Prefix:DR
First Name:YUSHEN
Middle Name:WANG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YUEH
Other - Middle Name:XIAN
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0011
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:12525 PERKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1907
Practice Address - Country:US
Practice Address - Phone:225-765-4256
Practice Address - Fax:225-765-4034
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1042773Medicaid
LAP00185296OtherRAILROAD MEDICARE
LAP00185296OtherRAILROAD MEDICARE
LAI20596Medicare UPIN
LA4J0947881Medicare PIN
LA4J094C822Medicare PIN