Provider Demographics
NPI:1881749745
Name:LEE, BLONG VANGKHUE
Entity type:Individual
Prefix:MR
First Name:BLONG
Middle Name:VANGKHUE
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 MORAN AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-9737
Mailing Address - Country:US
Mailing Address - Phone:029-357-8161
Mailing Address - Fax:
Practice Address - Street 1:808 W 16TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4600
Practice Address - Country:US
Practice Address - Phone:029-381-6830
Practice Address - Fax:209-383-9666
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator