Healthcare Provider Details

I. General information

NPI: 1568726404
Provider Name (Legal Business Name): SEUNG P LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N HOPE ST RM 538
LOS ANGELES CA
90012-2607
US

IV. Provider business mailing address

111 N HOPE ST RM 538
LOS ANGELES CA
90012-2607
US

V. Phone/Fax

Practice location:
  • Phone: 213-367-2001
  • Fax:
Mailing address:
  • Phone: 213-367-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA134749
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125061588
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: