Provider Demographics
NPI:1194732347
Name:LEE, NICHOLAS SUNG-CHOON (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SUNG-CHOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 TERMINO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2151
Mailing Address - Country:US
Mailing Address - Phone:562-597-0376
Mailing Address - Fax:562-986-3870
Practice Address - Street 1:1760 TERMINO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2105
Practice Address - Country:US
Practice Address - Phone:562-597-0376
Practice Address - Fax:563-986-3870
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA323780207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0137716OtherMEDI-CAL PIN
CAA323780Medicaid
CAA84345Medicare UPIN
CAW6537Medicare ID - Type UnspecifiedMEDICARE