Provider Demographics
NPI:1598721284
Name:LEE, JOHN KWANGHYUK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KWANGHYUK
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 1:400 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1625
Mailing Address - Country:US
Mailing Address - Phone:626-964-3326
Mailing Address - Fax:626-964-3346
Practice Address - Street 1:400 N. EUCLID ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:91748-1625
Practice Address - Country:US
Practice Address - Phone:626-964-3326
Practice Address - Fax:626-964-3346
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12405Medicare UPIN
CAA66137Medicare ID - Type Unspecified