Provider Demographics
NPI:1295296598
Name:LEE, BRIAN KISUB (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KISUB
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S LUCERNE BLVD APT 112
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-3783
Mailing Address - Country:US
Mailing Address - Phone:213-210-8763
Mailing Address - Fax:
Practice Address - Street 1:3948 WILSHIRE BLVD # 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3303
Practice Address - Country:US
Practice Address - Phone:323-289-8601
Practice Address - Fax:323-289-8603
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor