Provider Demographics
NPI:1508156316
Name:LEE, ELLY R (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLY
Middle Name:R
Last Name:LEE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2515 MCCABE WAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-9401
Mailing Address - Country:US
Mailing Address - Phone:949-753-1663
Mailing Address - Fax:949-753-4761
Practice Address - Street 1:2515 MCCABE WAY
Practice Address - Street 2:SUITE 350
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-9401
Practice Address - Country:US
Practice Address - Phone:949-753-1663
Practice Address - Fax:949-753-4761
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2016-11-16
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Provider Licenses
StateLicense IDTaxonomies
CAA0521792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry