Provider Demographics
NPI:1205642634
Name:LEE, BRIAN KHO (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KHO
Last Name:LEE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:222 MAZATLAN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5262
Mailing Address - Country:US
Mailing Address - Phone:626-698-8184
Mailing Address - Fax:
Practice Address - Street 1:10105 BANBURRY CROSS DR STE 445
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6645
Practice Address - Country:US
Practice Address - Phone:702-475-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical