Provider Demographics
NPI:1144363995
Name:SINGH A. BOUN, MD & NICK LEE, MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SINGH A. BOUN, MD & NICK LEE, MD, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SINGH
Authorized Official - Middle Name:AHN
Authorized Official - Last Name:BOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-280-5000
Mailing Address - Street 1:210 N GARFIELD AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1746
Mailing Address - Country:US
Mailing Address - Phone:626-280-5000
Mailing Address - Fax:626-280-5100
Practice Address - Street 1:210 N GARFIELD AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1746
Practice Address - Country:US
Practice Address - Phone:626-280-5000
Practice Address - Fax:626-280-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79658208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A796581Medicaid
CA00A796580Medicaid
CA00A796580Medicaid
CA00A796581Medicaid