MEDICARE: NICHOLAS SUNG-CHOON 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	207V00000X	Obstetrics & Gynecology Physician	A323780	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0137716	OTHER	CA	MEDI-CAL PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194732347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS SUNG-CHOON LEE M.D.

Provider Business Mailing Address
First Line	:	1760 TERMINO AVE
Second Line	:	SUITE 200
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2151
Country	:	US
Telephone Number	:	562-597-0376
Fax Number	:	562-986-3870

Provider Business Practice Location Address
First Line	:	1760 TERMINO AVE
Second Line	:	SUITE 200
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2105
Country	:	US
Telephone Number	:	562-597-0376
Fax Number	:	563-986-3870

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/09/2007

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Directions to “ NICHOLAS SUNG-CHOON LEE M.D.” Practice Location

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