Individual
EDWARD SU-CHONG LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1140 W LA VETA AVE, STE. 520, ORANGE, CA 92868-4225
(714) 543-2000
Mailing address
PO BOX 5971, ORANGE, CA 92863-5971
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
A62692
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A626920
BLUE SHIELD OF CA
—
05
—
00A626920
—
CA
01
—
P00002597
RAILROAD MEDICARE
—
Enumeration date
07/18/2005
Last updated
08/15/2008
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