Provider Demographics
NPI:1285845651
Name:LEE, MICHAEL BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660653
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-0653
Mailing Address - Country:US
Mailing Address - Phone:310-890-4764
Mailing Address - Fax:
Practice Address - Street 1:801 CORPORATE CENTER DR STE 130
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2639
Practice Address - Country:US
Practice Address - Phone:909-623-1985
Practice Address - Fax:909-623-4988
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1032390200000X
CA20A10591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program