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NPI Code Detail

MEDICARE: SAMUEL KYONG YOL LEE PHARM,D.

MEDICARE: SAMUEL KYONG YOL LEE PHARM,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
1183500000XPharmacist67341CA

General Provider Information

NPI Number : 1912254707
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL KYONG YOL LEE PHARM,D.
Provider Business Mailing Address
First Line : 540 S KENMORE AVE
Second Line : UNIT 706
City : LOS ANGELES
State : CA
Zip : 90020-2517
Country : US
Telephone Number : 213-375-7860
Fax Number :
Provider Business Practice Location Address
First Line : 1985 ZONAL AVE
Second Line : 106B
City : LOS ANGELES
State : CA
Zip : 90089-5305
Country : US
Telephone Number : 323-442-1369
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2012
Last Update Date : 08/10/2012

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