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General NPI Number Information
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NPI Number | 1114245883
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Entity Type | Organization
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Legal Business Name | YONG LUKE LEE MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 255 EAST BONITA
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City | POMONA
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State | CA
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Zip | 91769-6001
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Country | US
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Telephone | 909-450-0115
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Fax | 909-593-0096
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Provider Business Mailing Address
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Address Line | 8816 FOOTHILL BLVD STE 103
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-7199
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Country | US
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Telephone | 909-484-2865
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Fax | 909-941-6974
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Authorized Official
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Title or Position | OWNER
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Name | MR. YONG LUKE LEE
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Credential | MD
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Telephone | 909-484-2865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | A39217
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License Number State | CA
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