Provider Demographics
NPI:1912133364
Name:NEW LIGHT MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NEW LIGHT MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEONG-OK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-635-0600
Mailing Address - Street 1:1801 W ROMNEYA DR
Mailing Address - Street 2:STE #606
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1828
Mailing Address - Country:US
Mailing Address - Phone:714-635-0600
Mailing Address - Fax:714-635-0610
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:STE #606
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1828
Practice Address - Country:US
Practice Address - Phone:714-635-0600
Practice Address - Fax:714-635-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302F00000X, 305R00000X, 305S00000X
CAA39186302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service