Provider Demographics
NPI:1952497521
Name:LEE, JOSEPH I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:I
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3452 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3142
Mailing Address - Country:US
Mailing Address - Phone:626-793-2885
Mailing Address - Fax:626-793-6262
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1474
Practice Address - Country:US
Practice Address - Phone:818-952-1426
Practice Address - Fax:818-952-3843
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA69253207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A692530Medicaid
CAW2223DOtherPTAN
CAWA69253DMedicare PIN
CAHH176ZMedicare PIN
CA00A692530Medicaid