Provider Demographics
NPI:1578591459
Name:LEE, MICHAEL CHU-MING (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHU-MING
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 3383
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-3383
Mailing Address - Country:US
Mailing Address - Phone:858-472-3024
Mailing Address - Fax:
Practice Address - Street 1:16211 LOS ARBOLES
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067-9206
Practice Address - Country:US
Practice Address - Phone:858-472-3024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81265207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G812650Medicaid
CA00G812650OtherBLUE SHIELD
G58710Medicare UPIN
CA00G812650OtherBLUE SHIELD
CA00G812650Medicaid