Provider Demographics
NPI:1447271036
Name:LEE, YOUNG-JIK (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNG-JIK
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 1:3663 W 6TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3047
Mailing Address - Country:US
Mailing Address - Phone:213-383-9388
Mailing Address - Fax:
Practice Address - Street 1:3663 W 6TH ST STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3047
Practice Address - Country:US
Practice Address - Phone:213-383-9388
Practice Address - Fax:213-381-8660
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A813900Medicaid
CAH21200Medicare UPIN
CA00A813900Medicaid