MEDICARE: DR. DIANA DANTIAN LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	A85417	CA
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	15282	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1918273	OTHER	CA	GREAT WEST
2	111371	OTHER	CA	HEALTH NET
3	5632785	OTHER	CA	FIRST HEALTH
4	253808	OTHER	CA	INTERPLAN
5	7394657	OTHER	CA	AETNA
6	A85417	OTHER	CA	BLUE CROSS
7	MCMG413400	OTHER	CA	WESTERN HEALTH ADVANTAGE
8	2547985	OTHER	CA	UNITED HEALTHCARE
9	90197387	OTHER	CA	PACIFICARE
10	0884006	OTHER	CA	CIGNA

General Provider Information

NPI Number	:	1124125232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA DANTIAN LEE M.D.

Provider Business Mailing Address
First Line	:	10624 S EASTERN AVE STE A-955
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2982
Country	:	US
Telephone Number	:	702-407-7700
Fax Number	:	702-407-7016

Provider Business Practice Location Address
First Line	:	10624 S EASTERN AVE STE A-955
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-2982
Country	:	US
Telephone Number	:	702-407-7700
Fax Number	:	702-407-7016

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/02/2018

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