Provider Demographics
NPI:1699742189
Name:LEE, LANCE JEHONG (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:JEHONG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 E CHEVY CHASE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4199
Mailing Address - Country:US
Mailing Address - Phone:818-243-1501
Mailing Address - Fax:818-638-6191
Practice Address - Street 1:1500 E CHEVY CHASE DR STE 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4199
Practice Address - Country:US
Practice Address - Phone:818-243-1501
Practice Address - Fax:818-638-6191
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA613002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A613000Medicaid
CAWA61300AMedicare PIN
CAG94225Medicare UPIN