Provider Demographics
NPI:1720024383
Name:LEE, YOUNG D (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:D
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 1:320 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1816
Mailing Address - Country:US
Mailing Address - Phone:626-535-9315
Mailing Address - Fax:626-535-9315
Practice Address - Street 1:320 PALMETTO DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1816
Practice Address - Country:US
Practice Address - Phone:626-535-9315
Practice Address - Fax:626-535-9315
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31153207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A311530Medicaid
CA00A311531Medicaid
CAE01602Medicare UPIN
CA00A311530Medicaid