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NPI Code Detail

MEDICARE: DR. WAYNE GWONG LEE PSYD

MEDICARE: DR. WAYNE GWONG LEE PSYD
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1265647739
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WAYNE GWONG LEE PSYD
Provider Business Mailing Address
First Line : 1895 BLUFFHILL DR
Second Line :
City : MONTEREY PARK
State : CA
Zip : 91754-4534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3455 PERCY ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-1716
Country : US
Telephone Number : 323-268-2100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 11/18/2008

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Directions to “ DR. WAYNE GWONG LEE PSYD” Practice Location

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