Provider Demographics
NPI:1740458868
Name:PEN H. LEE, M.D., INC
Entity type:Organization
Organization Name:PEN H. LEE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PEN
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-571-6641
Mailing Address - Street 1:600 N GARFIELD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1168
Mailing Address - Country:US
Mailing Address - Phone:626-571-6641
Mailing Address - Fax:626-571-8457
Practice Address - Street 1:600 N GARFIELD AVE STE 110
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1168
Practice Address - Country:US
Practice Address - Phone:626-571-6641
Practice Address - Fax:626-571-6643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEN H. LEE, M.D., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-11
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44281208D00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092480Medicaid
CAGR0092480Medicaid
CAW15435Medicare PIN