Provider Demographics
NPI:1740206689
Name:LEE, HERBERT (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4870 BARRANCA PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4709
Mailing Address - Country:US
Mailing Address - Phone:949-552-9628
Mailing Address - Fax:949-552-3758
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:SUITE 315A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3167
Practice Address - Country:US
Practice Address - Phone:949-552-9628
Practice Address - Fax:949-552-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-02-20
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Provider Licenses
StateLicense IDTaxonomies
CAA41465207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79383Medicare UPIN