Provider Demographics
NPI:1104806199
Name:LEE, GIN-HORN DANIEL (DPM)
Entity type:Individual
Prefix:DR
First Name:GIN-HORN
Middle Name:DANIEL
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N GARFIELD AVE
Mailing Address - Street 2:SUITE#206
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1206
Mailing Address - Country:US
Mailing Address - Phone:626-572-8950
Mailing Address - Fax:626-572-9487
Practice Address - Street 1:420 N GARFIELD AVE
Practice Address - Street 2:SUITE#206
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1206
Practice Address - Country:US
Practice Address - Phone:626-572-8950
Practice Address - Fax:626-572-9487
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3887213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2905638Medicaid
CA2905638Medicaid
CAWE3887BMedicare PIN