Provider Demographics
NPI:1366458317
Name:AU, LEE KUEI WEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:KUEI WEN
Last Name:AU
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 1:3333 FULHAM CT
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3500
Mailing Address - Country:US
Mailing Address - Phone:808-280-4748
Mailing Address - Fax:
Practice Address - Street 1:3333 FULHAM CT
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3500
Practice Address - Country:US
Practice Address - Phone:808-280-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI5149174400000X
CAG88694174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI018633-01Medicaid
HI0000BDLXTMedicare ID - Type Unspecified
HI018633-01Medicaid