Provider Demographics
NPI:1811197536
Name:LEE, CHANG LI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:LI
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 1:399 E HIGHLAND AVE STE 223
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3864
Mailing Address - Country:US
Mailing Address - Phone:909-475-5200
Mailing Address - Fax:909-475-5255
Practice Address - Street 1:399 E HIGHLAND AVE STE 223
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3864
Practice Address - Country:US
Practice Address - Phone:909-475-5200
Practice Address - Fax:909-475-5255
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99010207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology