Healthcare Provider Details

I. General information

NPI: 1477870186
Provider Name (Legal Business Name): JOHN LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 02/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W FERN AVE
REDLANDS CA
92373-5916
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-5501
  • Fax:
Mailing address:
  • Phone: 909-583-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA119154
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA119154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: