Provider Demographics
NPI:1386720092
Name:LEE, WONUK (MD)
Entity type:Individual
Prefix:DR
First Name:WONUK
Middle Name:
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 1:2419 CASTILLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4301
Mailing Address - Country:US
Mailing Address - Phone:805-682-6363
Mailing Address - Fax:805-682-2287
Practice Address - Street 1:2419 CASTILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4301
Practice Address - Country:US
Practice Address - Phone:805-682-6363
Practice Address - Fax:805-682-2287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77205207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH85344Medicare UPIN