Provider Demographics
NPI:1194765479
Name:LEE, STANFORD CHIN (MD)
Entity type:Individual
Prefix:
First Name:STANFORD
Middle Name:CHIN
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 1:4401 W MEMORIAL ROAD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1722
Mailing Address - Country:US
Mailing Address - Phone:800-749-4560
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:501 S BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4809
Practice Address - Country:US
Practice Address - Phone:818-843-5111
Practice Address - Fax:405-749-4561
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G504290OtherBLUE SHIELD
G50429OtherBLUE CROSS
CA00G504290Medicaid
00G504290OtherBLUE SHIELD
WG50429DMedicare ID - Type Unspecified
010039638Medicare ID - Type UnspecifiedRAILROAD MEDICARE