Provider Demographics
NPI:1710986260
Name:LEE, YOUNG SOO (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:SOO
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 513969
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3969
Mailing Address - Country:US
Mailing Address - Phone:310-335-4065
Mailing Address - Fax:310-335-4098
Practice Address - Street 1:2151 N HARBOR BLVD STE 1500
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3823
Practice Address - Country:US
Practice Address - Phone:714-446-5632
Practice Address - Fax:714-992-3081
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG639082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G639080Medicaid
CAWG63908MMedicare PIN
CAWG63908LMedicare PIN
CABQ968Medicare PIN
CA00G639080Medicaid