Provider Demographics
NPI:1568717346
Name:LEE, WINFRED JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:WINFRED
Middle Name:JOHN
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 1:88 E BAY STATE ST
Mailing Address - Street 2:1-N
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-6820
Mailing Address - Country:US
Mailing Address - Phone:626-293-1664
Mailing Address - Fax:
Practice Address - Street 1:88 E BAY STATE ST
Practice Address - Street 2:1-N
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-6820
Practice Address - Country:US
Practice Address - Phone:626-293-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78553208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice