MEDICARE: EDWARD SU-CHONG LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	A62692	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00002597	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00A626920	OTHER		BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1114926672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD SU-CHONG LEE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5971
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92863-5971
Country	:	US
Telephone Number	:	714-571-5000
Fax Number	:	714-571-5055

Provider Business Practice Location Address
First Line	:	1140 W LA VETA AVE
Second Line	:	STE. 520
City	:	ORANGE
State	:	CA
Zip	:	92868-4225
Country	:	US
Telephone Number	:	714-543-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/15/2008

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Directions to “ EDWARD SU-CHONG LEE M.D.” Practice Location

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