Provider Demographics
NPI:1063432615
Name:LEE, KATHERINE EUNJU (MD, FAAFP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:EUNJU
Last Name:LEE
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Gender:F
Credentials:MD, FAAFP
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Mailing Address - Street 1:23451 MADISON ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4763
Mailing Address - Country:US
Mailing Address - Phone:310-791-0083
Mailing Address - Fax:310-791-0085
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:STE 250
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4761
Practice Address - Country:US
Practice Address - Phone:310-791-0083
Practice Address - Fax:310-791-0085
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA72902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI59576Medicare UPIN
CAPTAN AQ022YMedicare PIN