Provider Demographics
NPI:1245262013
Name:LEE, YU-HSIANG SAM (DO)
Entity type:Individual
Prefix:DR
First Name:YU-HSIANG
Middle Name:SAM
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1166
Mailing Address - Country:US
Mailing Address - Phone:626-927-9915
Mailing Address - Fax:626-927-9935
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1166
Practice Address - Country:US
Practice Address - Phone:626-927-9915
Practice Address - Fax:626-927-9935
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017351207Q00000X
CA20A12321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200602380AMedicaid
MO1245262013Medicaid
MOP00714623OtherRR MEDICARE
CACB217155Medicare PIN
MO701000024Medicare PIN