Provider Demographics
NPI:1992821516
Name:LEE, GRACE LI-YUEN HO (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:LI-YUEN HO
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4181
Mailing Address - Country:US
Mailing Address - Phone:626-808-2424
Mailing Address - Fax:928-343-7065
Practice Address - Street 1:3442 W 14TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4181
Practice Address - Country:US
Practice Address - Phone:626-808-2424
Practice Address - Fax:928-343-7065
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002438363A00000X
AZ3513363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant