MEDICARE: WOO SOK 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	207Q00000X	Family Medicine Physician	A85330	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A85330	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1386663185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WOO SOK LEE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-0206
Country	:	US
Telephone Number	:	213-385-0675
Fax Number	:	213-365-6429

Provider Business Practice Location Address
First Line	:	316 E BROADWAY
Second Line	:	SUITE B
City	:	GLENDALE
State	:	CA
Zip	:	91205-1011
Country	:	US
Telephone Number	:	818-956-2001
Fax Number	:	818-956-6331

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/14/2023

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