Provider Demographics
NPI:1134109200
Name:LEE, DONG HYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONG
Middle Name:HYUN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DONG
Other - Middle Name:H
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2727 W OLYMPIC BLVD STE 309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2699
Mailing Address - Country:US
Mailing Address - Phone:213-674-7758
Mailing Address - Fax:213-674-7857
Practice Address - Street 1:2727 W OLYMPIC BLVD STE 309
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2699
Practice Address - Country:US
Practice Address - Phone:213-674-7758
Practice Address - Fax:213-674-7857
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54193207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1772949OtherCIGNA
7808895OtherAETNA
P00430210OtherRAILROAD MEDICARE
W399 0010OtherBCBS FEDERAL
8168943OtherUNITED HEALTHCARE / MAMSI
WV3810008922Medicaid
MD412917200Medicaid
8168943OtherUNITED HEALTHCARE / MAMSI