Provider Demographics
NPI:1558457556
Name:LEE, BRIAN M (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
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 1:3625 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-3509
Mailing Address - Country:US
Mailing Address - Phone:310-763-7504
Mailing Address - Fax:310-763-7573
Practice Address - Street 1:3625 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE #5
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3509
Practice Address - Country:US
Practice Address - Phone:310-763-7504
Practice Address - Fax:310-763-7573
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86438207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A864380Medicaid
CA00A864380Medicaid
CAA86438Medicare PIN