Provider Demographics
NPI:1134205099
Name:LEE, HYO-RANG (MD,PHD)
Entity type:Individual
Prefix:
First Name:HYO-RANG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S VIRGIL AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1415
Mailing Address - Country:US
Mailing Address - Phone:213-739-0007
Mailing Address - Fax:213-739-0011
Practice Address - Street 1:505 S VIRGIL AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1415
Practice Address - Country:US
Practice Address - Phone:213-739-0007
Practice Address - Fax:213-739-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78554207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI38429Medicare UPIN