Provider Demographics
NPI:1780709253
Name:BUM SOO LEE
Entity type:Organization
Organization Name:BUM SOO LEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BUM SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-279-0684
Mailing Address - Street 1:179 S PERALTA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3424
Mailing Address - Country:US
Mailing Address - Phone:714-974-7368
Mailing Address - Fax:714-999-6686
Practice Address - Street 1:1020 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5851
Practice Address - Country:US
Practice Address - Phone:714-270-0684
Practice Address - Fax:714-999-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50244Medicare UPIN