Basic Information
| Provider Information | |||||||||
| NPI: | 1265479745 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | O-LEE | ||||||||
| FirstName: | TSUNGJU | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 601 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712298 | ||||||||
| FaxNumber: | 7023847506 | ||||||||
| Practice Location | |||||||||
| Address1: | 11234 ANDERSON ST RM 2586 | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923542804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095587884 | ||||||||
| FaxNumber: | 9095584819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 12/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/19/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | A77684 | CA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 12715 | NV | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.