Provider Demographics
NPI:1619171428
Name:LEE, PAUL C (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4160 WILSHIRE BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3567
Mailing Address - Country:US
Mailing Address - Phone:323-933-3111
Mailing Address - Fax:323-933-3393
Practice Address - Street 1:4160 WILSHIRE BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3567
Practice Address - Country:US
Practice Address - Phone:323-933-3111
Practice Address - Fax:323-933-3393
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG77461207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G77461Medicaid
CAWG77461Medicare ID - Type UnspecifiedINDIVIDUAL
CA00G77461Medicaid