Provider Demographics
NPI:1518026814
Name:LEE, JOHN WILLIAMS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAMS
Last Name:LEE
Suffix:
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:PO BOX 4505
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4505
Mailing Address - Country:US
Mailing Address - Phone:818-597-3800
Mailing Address - Fax:818-879-8272
Practice Address - Street 1:1111 WEST LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2804
Practice Address - Country:US
Practice Address - Phone:714-999-6080
Practice Address - Fax:714-999-3924
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA548102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHL141377OtherDEPT OF HEALTH SERVICES
CA00A548100Medicaid
CA00A548100Medicaid
H29442Medicare UPIN
WA54810BMedicare ID - Type Unspecified