Provider Demographics
NPI:1699016980
Name:LEE, DAVID JIN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 VERDUGO BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3024
Mailing Address - Country:US
Mailing Address - Phone:818-541-1134
Mailing Address - Fax:818-249-9420
Practice Address - Street 1:1975 VERDUGO BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3024
Practice Address - Country:US
Practice Address - Phone:818-541-1134
Practice Address - Fax:818-249-9420
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14782207Q00000X
MI5101020395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine