Provider Demographics
NPI:1275816423
Name:LEE, NIKI
Entity Type:Individual
Prefix:DR
First Name:NIKI
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5467 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4219
Mailing Address - Country:US
Mailing Address - Phone:323-525-0646
Mailing Address - Fax:323-525-1036
Practice Address - Street 1:5467 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4219
Practice Address - Country:US
Practice Address - Phone:323-525-0646
Practice Address - Fax:323-525-1036
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52968183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist