Provider Demographics
NPI:1619929510
Name:LEE, JOSEPH CHANG (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHANG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1650 S PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5613
Mailing Address - Country:US
Mailing Address - Phone:310-535-7015
Mailing Address - Fax:310-540-7167
Practice Address - Street 1:1650 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 302
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5613
Practice Address - Country:US
Practice Address - Phone:310-535-7015
Practice Address - Fax:310-540-7167
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA824242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH91073Medicare UPIN