Provider Demographics
NPI:1821105321
Name:LEE, CHING G (MD)
Entity Type:Individual
Prefix:
First Name:CHING
Middle Name:G
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 1:408 S. BEACH BLVD.
Mailing Address - Street 2:#203
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-527-9111
Mailing Address - Fax:714-527-7426
Practice Address - Street 1:408 S. BEACH BLVD.
Practice Address - Street 2:#203
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1877
Practice Address - Country:US
Practice Address - Phone:714-527-9111
Practice Address - Fax:714-527-7426
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61762207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G617620Medicaid
CAG61762Medicare ID - Type Unspecified
CA00G617620Medicaid