Healthcare Provider Details

I. General information

NPI: 1316657836
Provider Name (Legal Business Name): RENE LEE MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 ROCHESTER AVE STE 120
RANCHO CUCAMONGA CA
91730-0719
US

IV. Provider business mailing address

232 RAMONA AVE
SIERRA MADRE CA
91024-2430
US

V. Phone/Fax

Practice location:
  • Phone: 909-484-4900
  • Fax: 909-781-2949
Mailing address:
  • Phone: 626-236-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RENE YEUNG
Title or Position: PRESIDENT
Credential:
Phone: 626-236-7573