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General NPI Number Information
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NPI Number | 1457689879
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Entity Type | Organization
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Legal Business Name | CHAN LEE PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 7055 N. CHESTNUT AVE. SUITE #104
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City | FRESNO
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State | CA
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Zip | 93720
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Country | US
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Telephone | 559-435-5362
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Fax | 559-435-3784
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Provider Business Mailing Address
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Address Line | 7055 N. CHESTNUT AVE. SUITE #104
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City | FRESNO
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State | CA
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Zip | 93720
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Country | US
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Telephone | 559-435-5362
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Fax | 559-435-3784
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHAN WOO LEE
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Credential | M.D.
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Telephone | 562-299-7327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A89666
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License Number State | CA
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