Provider Demographics
NPI:1568587236
Name:MARK LEE M.D., INC.
Entity Type:Organization
Organization Name:MARK LEE M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHUN-LIANG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-695-6988
Mailing Address - Street 1:PO BOX 6265
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90609-6265
Mailing Address - Country:US
Mailing Address - Phone:562-695-6988
Mailing Address - Fax:562-692-2093
Practice Address - Street 1:11147 WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3007
Practice Address - Country:US
Practice Address - Phone:562-695-6988
Practice Address - Fax:562-692-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68664174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty