Provider Demographics
NPI:1457689879
Name:CHAN LEE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHAN LEE PROFESSIONAL CORPORATION
Other - Org Name:CHAN LEE WEIGHT LOSS AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-299-7327
Mailing Address - Street 1:7055 N. CHESTNUT AVE.
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-435-5362
Mailing Address - Fax:559-435-3784
Practice Address - Street 1:7055 N. CHESTNUT AVE.
Practice Address - Street 2:SUITE #104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-435-5362
Practice Address - Fax:559-435-3784
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAN LEE PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89666208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty