Provider Demographics
NPI:1962464115
Name:LEE, JOHN HON SANG (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HON SANG
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 EGERER PL
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1602
Mailing Address - Country:US
Mailing Address - Phone:714-879-5773
Mailing Address - Fax:
Practice Address - Street 1:7872 WALKER ST
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1748
Practice Address - Country:US
Practice Address - Phone:714-522-4009
Practice Address - Fax:714-522-7328
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH50314Medicare UPIN