Provider Demographics
NPI:1083922777
Name:LEE ORTHOPAEDIC INSTITUTE
Entity Type:Organization
Organization Name:LEE ORTHOPAEDIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-550-9910
Mailing Address - Street 1:1500 S CENTRAL AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2530
Mailing Address - Country:US
Mailing Address - Phone:818-550-9910
Mailing Address - Fax:
Practice Address - Street 1:1037 E PALMDALE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4745
Practice Address - Country:US
Practice Address - Phone:661-456-3177
Practice Address - Fax:661-266-1373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEE ORTHOPAEDIC INSTITUTE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67707332B00000X
CAG86203332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6238200001Medicare NSC