Healthcare Provider Details

I. General information

NPI: 1740458868
Provider Name (Legal Business Name): PEN H. LEE, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N GARFIELD AVE STE 110
MONTEREY PARK CA
91754-1168
US

IV. Provider business mailing address

600 N GARFIELD AVE STE 110
MONTEREY PARK CA
91754-1168
US

V. Phone/Fax

Practice location:
  • Phone: 626-571-6641
  • Fax: 626-571-6643
Mailing address:
  • Phone: 626-571-6641
  • Fax: 626-571-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA44281
License Number StateCA

VIII. Authorized Official

Name: DR. PEN HONG LEE
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 626-571-6641