Provider Demographics
NPI:1205903994
Name:LEE, VICTOR WONG (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:WONG
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 1:1839 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2344
Mailing Address - Country:US
Mailing Address - Phone:855-586-7336
Mailing Address - Fax:626-604-1062
Practice Address - Street 1:1839 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2344
Practice Address - Country:US
Practice Address - Phone:855-586-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-058968207RG0300X
CAA45617207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0826913Medicaid
LE0670205OtherMEDICARE
OH0826913Medicaid