Provider Demographics
NPI:1053374652
Name:LEE, SAM UN (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:UN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:UNSUK
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3338
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92834-3338
Mailing Address - Country:US
Mailing Address - Phone:714-952-2100
Mailing Address - Fax:714-952-2121
Practice Address - Street 1:3414 W BALL RD
Practice Address - Street 2:SUITE K
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3726
Practice Address - Country:US
Practice Address - Phone:714-952-2100
Practice Address - Fax:714-952-2121
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523910Medicaid
CAA52391Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAF86378Medicare UPIN