Provider Demographics
NPI:1063703890
Name:LEE, SCOTT HYUNSOO (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:HYUNSOO
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1901 TOWN AND COUNTRY DR
Mailing Address - Street 2:STE 104
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3611
Mailing Address - Country:US
Mailing Address - Phone:951-738-1417
Mailing Address - Fax:951-817-0789
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2507
Practice Address - Country:US
Practice Address - Phone:951-808-6298
Practice Address - Fax:951-523-7065
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2021-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA123118207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program