Provider Demographics
NPI:1467512624
Name:LEE, BRYAN XIAO-QIU (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:XIAO-QIU
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: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:909-593-1004
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91137208VP0014X, 207L00000X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine