MEDICARE: HYO SOO LEE

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY41635	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0543505	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1851495808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HYO SOO LEE

Provider Business Mailing Address
First Line	:	2013 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3503
Country	:	US
Telephone Number	:	213-483-8025
Fax Number	:	213-483-2640

Provider Business Practice Location Address
First Line	:	2013 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3503
Country	:	US
Telephone Number	:	213-483-8025
Fax Number	:	213-483-2640

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	HYO SOO LEE
Credential	:
Telephone Number	:	213-483-8025

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	04/01/2011

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Directions to “HYO SOO LEE ” Practice Location

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