Provider Demographics
NPI:1790843365
Name:LEE, EDMOND SAM (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:SAM
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1166
Mailing Address - Country:US
Mailing Address - Phone:626-573-5000
Mailing Address - Fax:626-573-5001
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1166
Practice Address - Country:US
Practice Address - Phone:626-573-5000
Practice Address - Fax:626-573-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA54583207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H31271Medicare UPIN