Provider Demographics
NPI:1891772026
Name:LEE, STEPHEN Y (MD,FACOG)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:MD,FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W BEVERLY BLVD
Mailing Address - Street 2:SUITE #227
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4312
Mailing Address - Country:US
Mailing Address - Phone:323-727-0367
Mailing Address - Fax:323-727-1955
Practice Address - Street 1:111 W BEVERLY BLVD
Practice Address - Street 2:SUITE #227
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4312
Practice Address - Country:US
Practice Address - Phone:323-727-0367
Practice Address - Fax:323-727-1955
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84382Medicare UPIN