Provider Demographics
NPI:1891716411
Name:LEE, MYLES EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:EDWIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11500 SAN VICENTE BLVD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6218
Mailing Address - Country:US
Mailing Address - Phone:310-826-2073
Mailing Address - Fax:310-826-9353
Practice Address - Street 1:3630 E IMPERIAL HIGHWAY
Practice Address - Street 2:SUITE 2101
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2636
Practice Address - Country:US
Practice Address - Phone:310-603-6562
Practice Address - Fax:310-669-8236
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90654208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G205261Medicaid
CA00G205261Medicaid
CAWG20526BMedicare ID - Type Unspecified
CABL1114850OtherDRUG ENFORCEMENT ADM