Provider Demographics
NPI:1093699126
Name:LANCE J. LEE M.D. INC
Entity type:Organization
Organization Name:LANCE J. LEE M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:JEHONG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-243-1501
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:818-638-7191
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:818-638-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699742189Medicaid