Provider Demographics
NPI:1114055290
Name:LEE, HOIL (MD)
Entity Type:Individual
Prefix:DR
First Name:HOIL
Middle Name:
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:PO BOX 4257
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9576
Mailing Address - Country:US
Mailing Address - Phone:562-402-9779
Mailing Address - Fax:562-402-9449
Practice Address - Street 1:21520 PIONEER BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2603
Practice Address - Country:US
Practice Address - Phone:562-402-9779
Practice Address - Fax:562-402-9449
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34379208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34379OtherSTATE LICENSE NUMBER
CA00A343790Medicaid
CAP00086261OtherRAILROAD MCARE ID#
CAA84619Medicare UPIN
CAA34379AMedicare ID - Type UnspecifiedMCARE PROVIDER ID#