Provider Demographics
NPI:1992807267
Name:LEE, PEN HONG (MD)
Entity type:Individual
Prefix:
First Name:PEN HONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:PENHONG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:#110
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-571-6641
Mailing Address - Fax:626-571-6643
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:#110
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-571-6641
Practice Address - Fax:626-571-6643
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44281208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A442810Medicaid
CA00A442810Medicaid
CAA44281Medicare ID - Type Unspecified