Provider Demographics
NPI:1396907432
Name:LEE, DUSTIN JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:JOHN
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N GARFIELD AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1170
Mailing Address - Country:US
Mailing Address - Phone:626-281-9111
Mailing Address - Fax:626-291-9499
Practice Address - Street 1:600 N GARFIELD AVE STE 210
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1170
Practice Address - Country:US
Practice Address - Phone:626-281-9111
Practice Address - Fax:626-291-9499
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10484390200000X, 208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty