Provider Demographics
NPI:1689939977
Name:NICHOLAS S.C. LEE M.D. INC
Entity Type:Organization
Organization Name:NICHOLAS S.C. LEE M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:SC
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-597-0376
Mailing Address - Street 1:1760 TERMINO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804
Mailing Address - Country:US
Mailing Address - Phone:562-597-0376
Mailing Address - Fax:562-986-3870
Practice Address - Street 1:1760 TERMINO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804
Practice Address - Country:US
Practice Address - Phone:562-597-0376
Practice Address - Fax:562-986-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A323780207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W6537Medicare PIN
CAA84345Medicare UPIN