Provider Demographics
NPI:1467525469
Name:LEE-HONG, GIN (MD)
Entity Type:Individual
Prefix:
First Name:GIN
Middle Name:
Last Name:LEE-HONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GIN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3833 WORSHAM AVE
Mailing Address - Street 2:301
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1745
Mailing Address - Country:US
Mailing Address - Phone:562-595-5479
Mailing Address - Fax:562-989-2911
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:315
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1516
Practice Address - Country:US
Practice Address - Phone:562-595-5479
Practice Address - Fax:562-989-2911
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72426208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G724260Medicaid