Provider Demographics
NPI:1063710408
Name:KENNETH W LEE & ASSOCIATES INC
Entity type:Organization
Organization Name:KENNETH W LEE & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-517-3501
Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91785-1306
Mailing Address - Country:US
Mailing Address - Phone:909-622-3800
Mailing Address - Fax:909-622-2600
Practice Address - Street 1:160 E ARTESIA ST
Practice Address - Street 2:SUITE 140
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2900
Practice Address - Country:US
Practice Address - Phone:909-622-3800
Practice Address - Fax:909-622-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79488207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A694880Medicaid
CA00A694880Medicaid
CAI34982Medicare UPIN