Provider Demographics
NPI:1952375966
Name:LEE, WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:885 S ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4733
Mailing Address - Country:US
Mailing Address - Phone:626-281-9111
Mailing Address - Fax:626-281-9499
Practice Address - Street 1:885 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4733
Practice Address - Country:US
Practice Address - Phone:626-281-9111
Practice Address - Fax:626-281-9499
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5519207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101100Medicaid
CA00AX55190Medicaid
CAGR0101100Medicaid
CA00AX55190Medicaid
CA20A5519Medicare ID - Type UnspecifiedWILLIAM LEE