MEDICARE: CHANG LEE MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A99010	CA

General Provider Information

NPI Number	:	1720234701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANG LEE MD INC

Provider Business Mailing Address
First Line	:	399 E HIGHLAND AVE STE 223
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3864
Country	:	US
Telephone Number	:	909-475-5200
Fax Number	:	909-247-3219

Provider Business Practice Location Address
First Line	:	399 E HIGHLAND AVE STE 223
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-3864
Country	:	US
Telephone Number	:	909-475-5200
Fax Number	:	909-247-3219

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. CHANG LI LEE
Credential	:	MD
Telephone Number	:	909-475-5200

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	10/23/2014

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Directions to “CHANG LEE MD INC ” Practice Location

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