Provider Demographics
NPI:1225008238
Name:LEE, CHRIS IKJOON (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:IKJOON
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 1:18897 COLIMA RD
Mailing Address - Street 2:STE B
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2977
Mailing Address - Country:US
Mailing Address - Phone:626-913-8010
Mailing Address - Fax:877-412-9783
Practice Address - Street 1:18897-B COLIMA RD.
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2977
Practice Address - Country:US
Practice Address - Phone:626-913-8010
Practice Address - Fax:626-913-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2576536Medicaid
CA00A889260Medicaid
CAWA88926AMedicare ID - Type UnspecifiedPROVIDER ID #
CAI32075Medicare UPIN