Healthcare Provider Details

I. General information

NPI: 1497041883
Provider Name (Legal Business Name): JOHN SUNGWON LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SUNG WON LEE MD

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S VIRGIL AVE STE 202
LOS ANGELES CA
90020-1448
US

IV. Provider business mailing address

500 S VIRGIL AVE STE 202
LOS ANGELES CA
90020-1448
US

V. Phone/Fax

Practice location:
  • Phone: 213-908-7707
  • Fax: 414-296-8769
Mailing address:
  • Phone: 213-908-7707
  • Fax: 213-671-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA123119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberA123119
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA123119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: