Provider Demographics
NPI:1982790812
Name:LEE, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3452 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3142
Mailing Address - Country:US
Mailing Address - Phone:626-793-2885
Mailing Address - Fax:626-793-6262
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-952-1426
Practice Address - Fax:818-952-3843
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG50428207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G504280Medicaid
CAW2223DOtherPTAN
CAFQ429ZMedicare PIN
CAW2223DOtherPTAN