Provider Demographics
NPI:1740289032
Name:LEE, GILBERT HAEGIL (MD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:HAEGIL
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:HAE
Other - Middle Name:GIL
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14305 MERIDIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518-3034
Mailing Address - Country:US
Mailing Address - Phone:951-251-7461
Mailing Address - Fax:
Practice Address - Street 1:14305 MERIDIAN PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92518-3034
Practice Address - Country:US
Practice Address - Phone:951-251-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine