Provider Demographics
NPI:1841240181
Name:PANMAN, LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:PANMAN
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 1:4455 W 117TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2241
Mailing Address - Country:US
Mailing Address - Phone:312-645-0444
Mailing Address - Fax:310-975-0599
Practice Address - Street 1:4455 W 117TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2241
Practice Address - Country:US
Practice Address - Phone:312-645-0444
Practice Address - Fax:310-975-0599
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23774208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A237740Medicaid
CA00A237740Medicaid