Organization Active NPI

Kenneth W Lee & Associates Inc

  • Gastroenterology Physician
  • Pomona, CA
National Provider Identifier
1063710408
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A79488 Issued in CA
Legal business name
KENNETH W LEE & ASSOCIATES INC
Practice address
210 W Bonita Ave Ste 140
Pomona, CA 91767-1866
Phone
(909) 622-3800
Fax
(909) 622-2600
NPI assigned
Mar 9, 2011
Last updated
Sep 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth W Lee, MDNPI 1417023227
Title
President
Phone
(909) 517-3501

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X A79488 CA Primary

Addresses

Primary practice location

210 W Bonita Ave Ste 140
Pomona, CA 91767-1866

Mailing address

PO Box 1306
Upland, CA 91785-1306
Phone (909) 622-3800

Other identifiers 1

IdentifierTypeStateIssuer
00A694880MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110812000484 CA Part B Supplier - Clinic/Group Practice 5698944312 Receives reassigned benefits from 2 practitioners
Practice locations: Chino Hills, CA; Pomona, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2110400Kenneth W Lee MD & Associates Inc210 W Bonita Ave Ste 140, Pomona, CA 91767AccreditationDec 10, 2026

National Provider Directory

National Provider Directory

Locations

160 E Artesia St
Ste 140
Pomona, CA 91767
Phone (626) 653-9395

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1063710408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1306",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917851306",
            "telephone_number": "909-622-3800",
            "fax_number": "909-622-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W BONITA AVE STE 140",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671866",
            "telephone_number": "909-622-3800",
            "fax_number": "909-622-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH W LEE & ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-09",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-517-3501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A79488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A694880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.