Provider Demographics
NPI:1497011290
Name:PAUL CHOONG HWAN LEE, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAUL CHOONG HWAN LEE, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-539-3232
Mailing Address - Street 1:9894 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844
Mailing Address - Country:US
Mailing Address - Phone:714-539-3232
Mailing Address - Fax:714-539-3555
Practice Address - Street 1:1401 S. BROOKHURST RD.
Practice Address - Street 2:SUITE 107
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833
Practice Address - Country:US
Practice Address - Phone:714-539-3232
Practice Address - Fax:714-539-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75260207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75260Medicare PIN
CAH42977Medicare UPIN