Basic Information
| Provider Information | |||||||||
| NPI: | 1033476072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | CHIN | ||||||||
| MiddleName: | CHANG | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6343 E MAIN ST STE 12 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852058955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808356100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6750 E BAYWOOD AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808356100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A127470 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | A127470 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 62493 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.