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Individual

EDWARD WAN-JAE LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3055 WILSHIRE BLVD STE 100, LOS ANGELES, CA 90010-1119
(213) 484-1000
Mailing address
3055 WILSHIRE BLVD STE 100, LOS ANGELES, CA 90010-1119
(213) 484-1000
(213) 484-2662

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
49176
MN
207W00000X
Ophthalmology Physician
Primary
A106255
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CC083Z
MEDICARE INDIV. PTAN
CA
05
ENROLLED
IA
05
ENROLLED
MN
01
W2067
MEDICARE GROUP PTAN
CA
Enumeration date
05/03/2007
Last updated
01/06/2022
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