Provider Demographics
NPI:1952023863
Name:SE-YOUNG LEE MD INC
Entity type:Organization
Organization Name:SE-YOUNG LEE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SEYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-879-9988
Mailing Address - Street 1:12 SUNRIVER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5402
Mailing Address - Country:US
Mailing Address - Phone:714-879-9988
Mailing Address - Fax:714-908-8146
Practice Address - Street 1:1706 W ORANGETHORPE AVE STE D
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4556
Practice Address - Country:US
Practice Address - Phone:714-879-9988
Practice Address - Fax:714-908-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty