Healthcare Provider Details

I. General information

NPI: 1558758383
Provider Name (Legal Business Name): JOHN LEE MD SLEEP CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
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: 414-296-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN SUNGWON LEE
Title or Position: CEO
Credential: MD
Phone: 213-400-8851