Healthcare Provider Details

I. General information

NPI: 1528238839
Provider Name (Legal Business Name): HO HYUNG LEE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 SIERRA AVE DEPT OF ORTHOPEDICS, MEDICAL OFFICE BUILDING 3
FONTANA CA
92335-6720
US

IV. Provider business mailing address

2477 HART AVE
SANTA CLARA CA
95050-5518
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-0036
  • Fax:
Mailing address:
  • Phone: 216-410-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA106920
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA106920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: