Healthcare Provider Details

I. General information

NPI: 1710914254
Provider Name (Legal Business Name): HASUNG LEE MD PEDIATIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 CRENSHAW BLVD #104
LOS ANGELES CA
90019
US

IV. Provider business mailing address

903 CRENSHAW BLVD #104
LOS ANGELES CA
90019
US

V. Phone/Fax

Practice location:
  • Phone: 323-931-8177
  • Fax: 323-931-8170
Mailing address:
  • Phone: 323-931-8177
  • Fax: 323-931-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HASUNG LEE
Title or Position: OWNER
Credential: M.D.
Phone: 323-931-8177