Provider Demographics
NPI:1154557734
Name:LA LEE OBGYN MEDICAL ASSOCIATE
Entity type:Organization
Organization Name:LA LEE OBGYN MEDICAL ASSOCIATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANGJOON
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-735-0100
Mailing Address - Street 1:PO BOX 76120
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90076-0120
Mailing Address - Country:US
Mailing Address - Phone:323-735-0100
Mailing Address - Fax:323-735-7300
Practice Address - Street 1:3130 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2484
Practice Address - Country:US
Practice Address - Phone:323-735-0100
Practice Address - Fax:323-735-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50371207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC50371Medicare PIN