Provider Demographics
NPI:1740224229
Name:LEE, VIRGINIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 PAINTER AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3158
Mailing Address - Country:US
Mailing Address - Phone:562-698-8588
Mailing Address - Fax:562-698-8388
Practice Address - Street 1:8135 PAINTER AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3158
Practice Address - Country:US
Practice Address - Phone:562-698-8588
Practice Address - Fax:562-698-8388
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-4143915OtherTAX ID
CABL5945576OtherDEA
CAG73200Medicare UPIN
CAW19569Medicare ID - Type Unspecified