Provider Demographics
NPI:1730181116
Name:LEE, HANSON TSUNG-HAN (MD)
Entity type:Individual
Prefix:
First Name:HANSON
Middle Name:TSUNG-HAN
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 1:612 W DUARTE RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7602
Mailing Address - Country:US
Mailing Address - Phone:626-821-2076
Mailing Address - Fax:626-821-0129
Practice Address - Street 1:612 W DUARTE RD
Practice Address - Street 2:SUITE 502
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7602
Practice Address - Country:US
Practice Address - Phone:626-821-2076
Practice Address - Fax:626-821-0129
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71457207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE5763OtherMEDICARE RAILROAD ID
CA00A714570Medicaid
CAW19559Medicare ID - Type UnspecifiedMEDICARE ID
CADE5763OtherMEDICARE RAILROAD ID