Healthcare Provider Details

I. General information

NPI: 1063703890
Provider Name (Legal Business Name): SCOTT HYUNSOO LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4244 RIVERWALK PKWY STE 290
RIVERSIDE CA
92505-3373
US

IV. Provider business mailing address

4244 RIVERWALK PKWY STE 290
RIVERSIDE CA
92505-3373
US

V. Phone/Fax

Practice location:
  • Phone: 951-520-9392
  • Fax: 951-520-9394
Mailing address:
  • Phone: 951-520-9392
  • Fax: 951-520-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA123118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: