Provider Demographics
NPI:1013907047
Name:LEE, BYUNG HO (MD)
Entity Type:Individual
Prefix:DR
First Name:BYUNG
Middle Name:HO
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:470 GREENFIELD AVE
Mailing Address - Street 2:305
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-3576
Mailing Address - Country:US
Mailing Address - Phone:559-537-0325
Mailing Address - Fax:559-537-0327
Practice Address - Street 1:470 GREENFIELD AVE
Practice Address - Street 2:305
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3576
Practice Address - Country:US
Practice Address - Phone:559-537-0325
Practice Address - Fax:559-537-0327
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC129773208VP0000X, 207L00000X
IL036056213207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056213Medicaid
C38963Medicare UPIN
ILL82715Medicare ID - Type Unspecified