Provider Demographics
NPI:1477816700
Name:LEE, GEORGE C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:C
Last Name:LEE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 LAS PALMITAS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3530
Mailing Address - Country:US
Mailing Address - Phone:323-259-8811
Mailing Address - Fax:323-259-8811
Practice Address - Street 1:1200 NORTH STATE
Practice Address - Street 2:CT-2B 300 LAC-USC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-9985
Practice Address - Country:US
Practice Address - Phone:323-226-6225
Practice Address - Fax:323-441-8123
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13768261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology