MEDICARE: DR. JOSEPH I LEE MD

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	207RC0000X	Cardiovascular Disease Physician	A69253	CA
2	207RI0011X	Interventional Cardiology Physician	A69253	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	W2223D	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1952497521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH I LEE MD

Provider Business Mailing Address
First Line	:	3452 E FOOTHILL BLVD
Second Line	:	SUITE 130
City	:	PASADENA
State	:	CA
Zip	:	91107-3142
Country	:	US
Telephone Number	:	626-793-2885
Fax Number	:	626-793-6262

Provider Business Practice Location Address
First Line	:	1808 VERDUGO BLVD
Second Line	:	SUITE 414
City	:	GLENDALE
State	:	CA
Zip	:	91208-1474
Country	:	US
Telephone Number	:	818-952-1426
Fax Number	:	818-952-3843

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/27/2015

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Directions to “ DR. JOSEPH I LEE MD” Practice Location

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