Provider Demographics
NPI:1104806421
Name:LEE, DON W (MD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:W
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 S CENTRAL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4609
Mailing Address - Country:US
Mailing Address - Phone:818-247-0160
Mailing Address - Fax:818-247-4628
Practice Address - Street 1:710 S CENTRAL AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4609
Practice Address - Country:US
Practice Address - Phone:818-247-0160
Practice Address - Fax:818-247-4628
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2016-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA34051207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A340510Medicaid
CAWA34051DMedicare PIN
CAA88017Medicare UPIN