Provider Demographics
NPI:1912075235
Name:LEE, CHUNG MIN (MD)
Entity Type:Individual
Prefix:MR
First Name:CHUNG
Middle Name:MIN
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 1:12121 E CARSONS ST
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716
Mailing Address - Country:US
Mailing Address - Phone:562-402-1449
Mailing Address - Fax:562-403-4648
Practice Address - Street 1:12121 E CARSONS ST
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716
Practice Address - Country:US
Practice Address - Phone:562-402-1449
Practice Address - Fax:562-403-4648
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A360831Medicaid