Provider Demographics
NPI:1497839864
Name:LEE, YONG SOOK LYNDA (MD)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:SOOK LYNDA
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:Y S
Other - Middle Name:LYNDA
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 E HAMILTON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0251
Mailing Address - Country:US
Mailing Address - Phone:408-866-1135
Mailing Address - Fax:
Practice Address - Street 1:50 E HAMILTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0251
Practice Address - Country:US
Practice Address - Phone:408-866-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64264207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642640Medicare PIN