Provider Demographics
NPI:1760468508
Name:LEE, YONG L (MD)
Entity Type:Individual
Prefix:
First Name:YONG
Middle Name:L
Last Name:LEE
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 1:8816 FOOTHILL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7199
Mailing Address - Country:US
Mailing Address - Phone:909-484-2865
Mailing Address - Fax:909-941-6974
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:909-596-7845
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13096Medicare ID - Type Unspecified
CAE01630Medicare UPIN