Provider Demographics
NPI:1619960705
Name:LEE, WILLIAM ANG (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANG
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 1:2755 ALAMO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1311
Mailing Address - Country:US
Mailing Address - Phone:818-726-1930
Mailing Address - Fax:818-878-1563
Practice Address - Street 1:2755 ALAMO ST STE 101
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065
Practice Address - Country:US
Practice Address - Phone:818-726-1930
Practice Address - Fax:818-878-1563
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G26273Medicare UPIN