Healthcare Provider Details

I. General information

NPI: 1770106478
Provider Name (Legal Business Name): DANIEL JOONGOO LEE DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E CESAR E CHAVEZ AVE STE 230
LOS ANGELES CA
90033-2496
US

IV. Provider business mailing address

1701 E CESAR E CHAVEZ AVE STE 230
LOS ANGELES CA
90033-2496
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-1100
  • Fax: 323-226-1101
Mailing address:
  • Phone: 323-226-1100
  • Fax: 323-226-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: