Provider Demographics
NPI:1730311226
Name:LEE, LILY F (MD)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:F
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. CALIFORNIA BLVD.
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-817-0818
Mailing Address - Fax:626-817-0844
Practice Address - Street 1:100 E. CALIFORNIA BLVD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-817-0818
Practice Address - Fax:626-817-0844
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87024208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGL260XOtherMCR ( N)
CA1699038620Medicaid
CAGL260ZOtherMCR (S)