| Dr Samuel Shin Kwon Lee, MD | |
|
18400 Us Highway 18, Apple Valley, CA 92307-2306 | |
| (760) 242-3939 | |
| (760) 242-3232 |
| Full Name | Dr Samuel Shin Kwon Lee |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Experience | 35 Years |
| Location | 18400 Us Highway 18, Apple Valley, California |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194772418 | NPI | - | NPPES |
| 785000022 | Other | MO | MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 110101 (Missouri) | Secondary |
| 208800000X | Urology | 060213 (Georgia) | Secondary |
| 208800000X | Urology | A49819 (California) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Desert Valley Hospital | Victorville, CA | Hospital |
| St Mary Medical Center | Apple valley, CA | Hospital |
| Victor Valley Global Medical Center | Victorville, CA | Hospital |
| Barstow Community Hospital | Barstow, CA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Urologic Institute Of The High Desert Inc | 3476681008 | 11 |
| Desert Valley Medical Group Inc | 4880595875 | 70 |
| Palm Valley Multi-specialty Medical Group Pc | 8628412418 | 11 |
| Entity Name | Desert Valley Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1639117864 PECOS PAC ID: 4880595875 Enrollment ID: O20040113000803 |
| Entity Name | Halo Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467506451 PECOS PAC ID: 7012806052 Enrollment ID: O20040315001110 |
| Entity Name | Urologic Institute Of The High Desert Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1376867333 PECOS PAC ID: 3476681008 Enrollment ID: O20100503000190 |
| Entity Name | Palm Valley Multi-specialty Medical Group Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770344186 PECOS PAC ID: 8628412418 Enrollment ID: O20240220003822 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Samuel Shin Kwon Lee, MD 18400 Us Highway 18, Apple Valley, CA 92307-2306 Ph: (760) 242-3939 | Dr Samuel Shin Kwon Lee, MD 18400 Us Highway 18, Apple Valley, CA 92307-2306 Ph: (760) 242-3939 |
Venkat R Vangala, MD Urology Medicare: Not Enrolled in Medicare Practice Location: 18002 Highway 18, Apple Valley, CA 92307 Phone: 706-946-6000 Fax: 760-242-3502 | |
Dr. Pedram Ilbeigi, D.O. Urology Medicare: Accepting Medicare Assignments Practice Location: 18400 Us Highway 18, Suite A, Apple Valley, CA 92307 Phone: 760-242-3939 | |
Vodur C Reddy, MD Urology Medicare: Medicare Enrolled Practice Location: 18400 Us Highway 18, Suite A, Apple Valley, CA 92307 Phone: 760-242-3939 |