Healthcare Provider Details

I. General information

NPI: 1376784447
Provider Name (Legal Business Name): EDWARD SANG JOON LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ 7501Q
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ SUITE 7501Q
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-9643
  • Fax: 310-267-3840
Mailing address:
  • Phone: 310-825-8041
  • Fax: 310-267-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA107027
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA107027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: