Provider Demographics
NPI:1518126259
Name:BRIAN M LEE MD INC
Entity Type:Organization
Organization Name:BRIAN M LEE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-763-7504
Mailing Address - Street 1:3625 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262
Mailing Address - Country:US
Mailing Address - Phone:310-763-7504
Mailing Address - Fax:310-763-7573
Practice Address - Street 1:3625 MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-763-7504
Practice Address - Fax:310-763-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86438207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518126259Medicaid
CAAR349AMedicare PIN
CA1518126259Medicaid