Provider Demographics
NPI:1326406463
Name:LEE, BRIAN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 PUTNAM BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4650
Mailing Address - Country:US
Mailing Address - Phone:925-943-1119
Mailing Address - Fax:925-943-2493
Practice Address - Street 1:3161 PUTNAM BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4650
Practice Address - Country:US
Practice Address - Phone:925-943-1119
Practice Address - Fax:925-943-2493
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50283222Z00000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management