Provider Demographics
NPI:1962669747
Name:YONG SOOK LYNDA LEE MD
Entity Type:Organization
Organization Name:YONG SOOK LYNDA LEE MD
Other - Org Name:Y.S. LYNDA LEE, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:Y.S.
Authorized Official - Middle Name:LYNDA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-3181
Mailing Address - Street 1:2512 SAMARITAN CT STE P
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4002
Mailing Address - Country:US
Mailing Address - Phone:408-356-6108
Mailing Address - Fax:
Practice Address - Street 1:2512 SAMARITAN CT STE P
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4002
Practice Address - Country:US
Practice Address - Phone:408-356-6108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64264207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642640Medicare PIN
CAF73429Medicare UPIN