Provider Demographics
NPI:1922023043
Name:LEE, SAMUEL K (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:201 S ALVARADO ST
Mailing Address - Street 2:SUITE 622
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2320
Mailing Address - Country:US
Mailing Address - Phone:213-413-2622
Mailing Address - Fax:213-413-2922
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 622
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-413-2622
Practice Address - Fax:213-413-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70695208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70695Medicaid
CAG70695Medicare ID - Type Unspecified
CAG10900Medicare UPIN