MEDICARE: HYO-RANG LEE M.D.,PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	A78554	CA

General Provider Information

NPI Number	:	1134205099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYO-RANG LEE M.D.,PH.D

Provider Business Mailing Address
First Line	:	505 S VIRGIL AVE
Second Line	:	SUITE 208
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1415
Country	:	US
Telephone Number	:	213-739-0007
Fax Number	:	213-739-0011

Provider Business Practice Location Address
First Line	:	505 S VIRGIL AVE
Second Line	:	SUITE 208
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1415
Country	:	US
Telephone Number	:	213-739-0007
Fax Number	:	213-739-0011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	05/21/2014

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