Provider Demographics
NPI:1780040840
Name:JOHN J LEE MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN J LEE MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAYYAB
Authorized Official - Middle Name:
Authorized Official - Last Name:WASEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:628-203-3493
Mailing Address - Street 1:42 CALLE DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5210
Mailing Address - Country:US
Mailing Address - Phone:310-528-0764
Mailing Address - Fax:
Practice Address - Street 1:35400 BOB HOPE DR STE 206
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1774
Practice Address - Country:US
Practice Address - Phone:310-528-0764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty