MEDICARE: DR. SHAWN D. LEE D.C.

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	111N00000X	Chiropractor	DC29789	CA

General Provider Information

NPI Number	:	1194775072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN D. LEE D.C.

Provider Business Mailing Address
First Line	:	525 S BERENDO ST
Second Line	:	# 205
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-2284
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 SHATTO PL
Second Line	:	# 203
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1754
Country	:	US
Telephone Number	:	213-736-0450
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	05/21/2008

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