Provider Demographics
NPI:1497744353
Name:LEE, MILTON IRVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:IRVEN
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 1:3680 E IMPERIAL HWY
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-2659
Mailing Address - Country:US
Mailing Address - Phone:310-635-5857
Mailing Address - Fax:310-635-0102
Practice Address - Street 1:3680 E IMPERIAL HWY
Practice Address - Street 2:SUITE 460
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2659
Practice Address - Country:US
Practice Address - Phone:310-635-5857
Practice Address - Fax:310-635-0102
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38735207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC46526Medicare UPIN
CAG38735Medicare ID - Type UnspecifiedPROVIDER NUMBER