Provider Demographics
NPI:1114245883
Name:YONG LUKE LEE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:YONG LUKE LEE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YONG
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-484-2865
Mailing Address - Street 1:8816 FOOTHILL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7199
Mailing Address - Country:US
Mailing Address - Phone:909-484-2865
Mailing Address - Fax:909-941-6974
Practice Address - Street 1:255 EAST BONITA
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91769-6001
Practice Address - Country:US
Practice Address - Phone:909-450-0115
Practice Address - Fax:909-593-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39217283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114245883Medicaid