Provider Demographics
NPI:1811215353
Name:LEE, ELMO SHIN (MD)
Entity type:Individual
Prefix:
First Name:ELMO
Middle Name:SHIN
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 1:82485 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4249
Mailing Address - Country:US
Mailing Address - Phone:760-347-4347
Mailing Address - Fax:760-342-7829
Practice Address - Street 1:82485 MILES AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4249
Practice Address - Country:US
Practice Address - Phone:760-347-4347
Practice Address - Fax:760-342-7829
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG648102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry