Provider Demographics
NPI:1922019348
Name:LEE, SEUNG M (MD)
Entity type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:M
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W CARSON ST STE D
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2051
Mailing Address - Country:US
Mailing Address - Phone:213-427-0667
Mailing Address - Fax:424-488-2177
Practice Address - Street 1:1001 W CARSON ST STE D
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2051
Practice Address - Country:US
Practice Address - Phone:213-427-0667
Practice Address - Fax:424-488-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8699336Medicare UPIN