Provider Demographics
NPI:1205008950
Name:LEE, JAMES S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19950 RINALDI ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4141
Mailing Address - Country:US
Mailing Address - Phone:818-271-2400
Mailing Address - Fax:818-360-4204
Practice Address - Street 1:19950 RINALDI ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4141
Practice Address - Country:US
Practice Address - Phone:818-271-2400
Practice Address - Fax:818-271-2401
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90106207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205008950OtherCALIFORNIA CHILDREN'S SERVICES (CCS PANELED) PROGRAM
CA1205008950Medicaid
CACB268TMedicare PIN
CACB268ZMedicare PIN
CACB268YMedicare PIN
CACB268QMedicare PIN
CA1205008950Medicaid
CACB268WMedicare PIN
CACB268XMedicare PIN
CACB268UMedicare PIN
CACB268VMedicare PIN
CA1205008950OtherCALIFORNIA CHILDREN'S SERVICES (CCS PANELED) PROGRAM