Provider Demographics
NPI:1053334748
Name:LEE, WAI S (MD)
Entity type:Individual
Prefix:DR
First Name:WAI
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:205 E RIVER PARK CIR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1571
Mailing Address - Country:US
Mailing Address - Phone:559-261-4500
Mailing Address - Fax:559-261-4501
Practice Address - Street 1:205 E RIVER PARK CIR
Practice Address - Street 2:SUITE 460
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1571
Practice Address - Country:US
Practice Address - Phone:559-261-4500
Practice Address - Fax:559-261-4501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA00G552110208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89987Medicare UPIN
CA00G552110Medicare PIN