Provider Demographics
NPI:1780761353
Name:LEE, RICHARD W (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
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 1:16415 COLORADO AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-5054
Mailing Address - Country:US
Mailing Address - Phone:562-531-0015
Mailing Address - Fax:562-531-4856
Practice Address - Street 1:16415 COLORADO AVE STE 208
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5054
Practice Address - Country:US
Practice Address - Phone:562-531-0015
Practice Address - Fax:562-531-4856
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85452207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI10907Medicare UPIN