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General NPI Number Information
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NPI Number | 1710914254
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Entity Type | Organization
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Legal Business Name | HASUNG LEE MD PEDIATIC CLINIC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 903 CRENSHAW BLVD #104
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City | LOS ANGELES
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State | CA
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Zip | 90019
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Country | US
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Telephone | 323-931-8177
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Fax | 323-931-8170
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Provider Business Mailing Address
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Address Line | 903 CRENSHAW BLVD #104
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City | LOS ANGELES
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State | CA
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Zip | 90019
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Country | US
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Telephone | 323-931-8177
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Fax | 323-931-8170
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Authorized Official
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Title or Position | OWNER
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Name | DR. HASUNG LEE
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Credential | M.D.
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Telephone | 323-931-8177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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