Provider Demographics
NPI:1508294679
Name:LEE, JOHN KANG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KANG
Last Name:LEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2633
Mailing Address - Country:US
Mailing Address - Phone:213-382-6391
Mailing Address - Fax:213-387-7475
Practice Address - Street 1:2732 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2633
Practice Address - Country:US
Practice Address - Phone:213-382-6391
Practice Address - Fax:213-387-7475
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69496183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist