| Jongserk Robert Lee, DO, MS | |
|
4601 Dale Rd, Modesto, CA 95356-9718 | |
| (209) 735-5000 | |
| Not Available |
| Full Name | Jongserk Robert Lee |
|---|---|
| Gender | Male |
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 4601 Dale Rd, Modesto, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861999005 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 17556 (California) | Primary |
| Entity Name | Permanente Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710 |
| Entity Name | Golden Valley Health Centers |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356445753 PECOS PAC ID: 4183527187 Enrollment ID: O20040128000641 |
| Mailing Address | Practice Location Address |
|---|---|
| Jongserk Robert Lee, DO, MS 1000 W Carson St # 432, Torrance, CA 90502-2059 Ph: (424) 306-6520 | Jongserk Robert Lee, DO, MS 4601 Dale Rd, Modesto, CA 95356-9718 Ph: (209) 735-5000 |
Jonathan Kistler, M.D. Psychiatry & Neurology Medicare: Medicare Enrolled Practice Location: 1001 Needham St, Modesto, CA 95354 Phone: 209-569-0373 Fax: 209-529-8519 | |
Tonya F. Fuller, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 600 Coffee Rd, Modesto, CA 95355 Phone: 209-550-4785 | |
Kairav Rameshchandra Shah, MD Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 1524 Mchenry Ave Ste 445, Modesto, CA 95350 Phone: 209-571-1693 | |
Dr. Jaaneali Mehdi, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 1501 Claus Rd Ste F, Modesto, CA 95355 Phone: 095-576-3102 | |
Vinita Wadhwani, MD Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 1400 Celeste Drive, Crestwood Mannor, Modesto, CA 95355 Phone: 916-422-5856 Fax: 916-422-2307 | |
Nusrat Malik, M.D. Psychiatry & Neurology Medicare: Not Enrolled in Medicare Practice Location: 1501 Claus Rd, Dbhc, Modesto, CA 95355 Phone: 209-557-6300 | |
Antoun C. Manganas, M.D. Psychiatry & Neurology Medicare: Accepting Medicare Assignments Practice Location: 1501 Claus Rd, Modesto, CA 95355 Phone: 209-524-9401 |