1548566599 NPI number — EDWARD H LEE DO INC

Table of content: (NPI 1548566599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548566599 NPI number — EDWARD H LEE DO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD H LEE DO INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548566599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 HOLLAND STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618-2568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-588-2190
Provider Business Mailing Address Fax Number:
949-588-2199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9080 COLIMA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90605-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-945-3561
Provider Business Practice Location Address Fax Number:
714-647-1245
Provider Enumeration Date:
02/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-347-1010

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  20A11037 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DU4887 . This is a "RR PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".