MEDICARE: JOSEPH CHANG 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	2084P0800X	Psychiatry Physician	A82424	CA

General Provider Information

NPI Number	:	1619929510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CHANG LEE M.D.

Provider Business Mailing Address
First Line	:	1650 S PACIFIC COAST HWY
Second Line	:	SUITE 302
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5613
Country	:	US
Telephone Number	:	310-535-7015
Fax Number	:	310-540-7167

Provider Business Practice Location Address
First Line	:	1650 S PACIFIC COAST HWY
Second Line	:	SUITE 302
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5613
Country	:	US
Telephone Number	:	310-535-7015
Fax Number	:	310-540-7167

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	01/25/2008

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