Provider Demographics
NPI:1003246018
Name:HYO RANG LEE MD PHD CORPORATION
Entity Type:Organization
Organization Name:HYO RANG LEE MD PHD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HYO
Authorized Official - Middle Name:RANG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-254-7103
Mailing Address - Street 1:4465 WILSHIRE BLVD
Mailing Address - Street 2:STE 303
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3704
Mailing Address - Country:US
Mailing Address - Phone:213-254-7103
Mailing Address - Fax:714-220-2301
Practice Address - Street 1:4465 WILSHIRE BLVD
Practice Address - Street 2:STE 303
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3704
Practice Address - Country:US
Practice Address - Phone:213-254-7103
Practice Address - Fax:714-220-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78554207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI38429Medicare UPIN