Provider Demographics
NPI:1184796104
Name:LEE, TERRY M (MD)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1166
Mailing Address - Country:US
Mailing Address - Phone:626-280-3651
Mailing Address - Fax:626-280-3079
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1166
Practice Address - Country:US
Practice Address - Phone:626-280-3651
Practice Address - Fax:626-280-3079
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G624520Medicaid
CA95-4745403OtherTAX ID#
CAW18608Medicare PIN
CA00G624520Medicaid
CAWG62452AMedicare ID - Type UnspecifiedGROUP PPIN#