Provider Demographics
NPI:1598793002
Name:LEE, CARLTON YS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:YS
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 1:201 S ALVARADO ST
Mailing Address - Street 2:SUITE 803
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2320
Mailing Address - Country:US
Mailing Address - Phone:213-413-5663
Mailing Address - Fax:213-413-1295
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 803
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-413-5663
Practice Address - Fax:213-413-1295
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92463Medicare UPIN
CAG44055Medicare ID - Type Unspecified