Provider Demographics
NPI:1992780225
Name:LEE, WONIL (MD)
Entity type:Individual
Prefix:DR
First Name:WONIL
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 1:12660 RIVERSIDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3429
Mailing Address - Country:US
Mailing Address - Phone:818-980-7010
Mailing Address - Fax:818-980-7330
Practice Address - Street 1:12660 RIVERSIDE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-3429
Practice Address - Country:US
Practice Address - Phone:818-980-7010
Practice Address - Fax:818-980-7330
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29899Medicare UPIN