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General NPI Number Information
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NPI Number | 1467564757
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Entity Type | Organization
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Legal Business Name | KOREA MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/12/2010
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Provider Practice Location Address
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Address Line | 3544 W OLYMPIC BLVD STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90019-3529
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Country | US
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Telephone | 323-731-0681
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Fax | 323-731-0832
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Provider Business Mailing Address
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Address Line | 3544 W OLYMPIC BLVD STE 105
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City | LOS ANGELES
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State | CA
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Zip | 90019-3529
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Country | US
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Telephone | 323-731-0681
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Fax | 323-731-0832
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. YONG TAI LEE
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Credential | M.D.
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Telephone | 323-731-0681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G67974
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License Number State | CA
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