Individual
DAE-WON LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9961 SIERRA AVE, FONTANA, CA 92335-6720
(909) 724-5000
Mailing address
PHR GROUP PROVIDER ENROLLMENT UNIT, 393 E WALNUT ST FL 3, PASADENA, CA 91188-0001
(877) 608-0044
(877) 514-0903
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2015021362
MO
207P00000X
Emergency Medicine Physician
Primary
A152262
CA
Other
Enumeration date
07/10/2015
Last updated
05/01/2025
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