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General NPI Number Information
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NPI Number | 1215189550
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Entity Type | Individual
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Provider Name | EDWARD WOLFGANG LEE MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ STE 2125B
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-267-8751
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Fax | 310-206-3631
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A97746
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A97746
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License Number State | CA
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