MEDICARE: CHING G. LEE M.D. INC

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	207R00000X	Internal Medicine Physician	G61762	CA

General Provider Information

NPI Number	:	1447586920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHING G. LEE M.D. INC

Provider Business Mailing Address
First Line	:	408 S. BEACH BLVD.
Second Line	:	#203
City	:	ANAHEIM
State	:	CA
Zip	:	92804
Country	:	US
Telephone Number	:	714-527-9111
Fax Number	:	714-527-7426

Provider Business Practice Location Address
First Line	:	408 S. BEACH BLVD
Second Line	:	#203
City	:	ANAHEIM
State	:	CA
Zip	:	92804-1877
Country	:	US
Telephone Number	:	714-527-9111
Fax Number	:	714-527-7426

Authorized Official
Title or Position	:	OWNER
Name	:	CHING G LEE
Credential	:	M.D.
Telephone Number	:	714-527-9111

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	06/28/2011

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