Provider Demographics
NPI:1609816917
Name:LEE, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHE-CHERNG
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:638 W DUARTE RD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7616
Mailing Address - Country:US
Mailing Address - Phone:626-574-6878
Mailing Address - Fax:626-574-2298
Practice Address - Street 1:638 W DUARTE RD
Practice Address - Street 2:SUITE 3A
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7616
Practice Address - Country:US
Practice Address - Phone:626-574-6878
Practice Address - Fax:626-574-2298
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA37292CMedicare PIN
CAA37292Medicare ID - Type Unspecified
CAB50347Medicare UPIN