MEDICARE: YONG L LEE MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A39217	CA

General Provider Information

NPI Number	:	1760468508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONG L LEE MD

Provider Business Mailing Address
First Line	:	8816 FOOTHILL BLVD STE 103
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-7199
Country	:	US
Telephone Number	:	909-484-2865
Fax Number	:	909-941-6974

Provider Business Practice Location Address
First Line	:	255 E BONITA AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-1923
Country	:	US
Telephone Number	:	909-596-7733
Fax Number	:	909-596-7845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	03/05/2024

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Directions to “ YONG L LEE MD” Practice Location

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