Healthcare Provider Details

I. General information

NPI: 1659565570
Provider Name (Legal Business Name): JOUNG UOONG LEE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 W 3RD ST
LOS ANGELES CA
90057-1901
US

IV. Provider business mailing address

101 S 1ST ST #1000
BURBANK CA
91502-1938
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-7111
  • Fax: 213-413-6338
Mailing address:
  • Phone: 818-845-6206
  • Fax: 818-845-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA31929
License Number StateCA

VIII. Authorized Official

Name: DR. JOUNG UOONG LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-845-6206