Provider Demographics
NPI:1144526773
Name:BRYAN X LEE MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:BRYAN X LEE MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:X
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-593-1002
Mailing Address - Street 1:PO BOX 2240
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91788-2240
Mailing Address - Country:US
Mailing Address - Phone:909-593-1002
Mailing Address - Fax:909-593-1004
Practice Address - Street 1:250 W BONITA AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1863
Practice Address - Country:US
Practice Address - Phone:909-593-1002
Practice Address - Fax:888-257-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-30
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91137207LP2900X, 208VP0014X
CAA96828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty