Provider Demographics
NPI:1932566858
Name:LEE, DAVID WON
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WON
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10280 INDIANA AVE.
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5357
Mailing Address - Country:US
Mailing Address - Phone:951-343-0428
Mailing Address - Fax:951-343-0438
Practice Address - Street 1:10280 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5357
Practice Address - Country:US
Practice Address - Phone:951-343-0428
Practice Address - Fax:951-343-0438
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76741332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies