Provider Demographics
NPI:1558353029
Name:LEE, CHENG-HONG JOHNSON (OD)
Entity Type:Individual
Prefix:DR
First Name:CHENG-HONG
Middle Name:JOHNSON
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18371 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-5532
Mailing Address - Country:US
Mailing Address - Phone:562-865-4190
Mailing Address - Fax:562-865-3280
Practice Address - Street 1:18371 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-5532
Practice Address - Country:US
Practice Address - Phone:562-865-4190
Practice Address - Fax:562-865-3280
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-10-26
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAOPT10361TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist