Provider Demographics
NPI:1619443108
Name:LEE, YONG K (PA-C)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:25150 HANCOCK AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5989
Mailing Address - Country:US
Mailing Address - Phone:951-587-3739
Mailing Address - Fax:951-698-5213
Practice Address - Street 1:25150 HANCOCK AVE STE 210
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5989
Practice Address - Country:US
Practice Address - Phone:951-587-3739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant