MEDICARE: POLKA HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician
3	2083P0901X	Public Health & General Preventive Medicine Physician

General Provider Information

NPI Number	:	1194476598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLKA HEALTH INC

Provider Business Mailing Address
First Line	:	PO BOX 1316
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91358-0316
Country	:	US
Telephone Number	:	747-287-9012
Fax Number	:

Provider Business Practice Location Address
First Line	:	2810 WHITE RIDGE PLACE
Second Line	:	17
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-9136
Country	:	US
Telephone Number	:	747-287-9012
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HYUNG MIN LEE
Credential	:	PHARMD
Telephone Number	:	747-287-9012

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	01/17/2022

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Directions to “POLKA HEALTH INC ” Practice Location

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