Individual
JASON GONG-FUNG LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
9695 BASE LINE RD, RANCHO CUCAMONGA, CA 91730-1314
(909) 940-0920
Mailing address
9695 BASE LINE RD, RANCHO CUCAMONGA, CA 91730-1314
(626) 941-0920
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA59315
CA
Other
Enumeration date
01/27/2021
Last updated
06/10/2024
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