Provider Demographics
NPI:1649271818
Name:LEE, CHOO S (MD)
Entity type:Individual
Prefix:DR
First Name:CHOO
Middle Name:S
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 1:680 GUZZI LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5288
Mailing Address - Country:US
Mailing Address - Phone:209-533-3955
Mailing Address - Fax:209-533-2168
Practice Address - Street 1:680 GUZZI LN
Practice Address - Street 2:SUITE 202
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5288
Practice Address - Country:US
Practice Address - Phone:209-533-3955
Practice Address - Fax:209-533-2168
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A447320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF06745Medicare UPIN
CA00A447320Medicare ID - Type Unspecified