MEDICARE: DYLAN LEE

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1225960990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN LEE

Provider Business Mailing Address
First Line	:	620 SHADOW LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4194
Country	:	US
Telephone Number	:	702-477-6576
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 SHADOW LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4194
Country	:	US
Telephone Number	:	702-477-6576
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

Similar Medicare Providers

1376473736 — AMANI ABU SAMHA M.D
Practice Location Address:

620 SHADOW LN
LAS VEGAS, NV
89106-4194

Practice Phone: 702-477-6572
Practice Fax:

1023948940 — ALEX HIRSCHFELD GOLDBACH MD
Practice Location Address:

620 SHADOW LN
LAS VEGAS, NV
89106-4194

Practice Phone: 702-477-6572
Practice Fax:

1477285542 — DR. LOGAN CHASE RADEMACHER DO
Practice Location Address:

620 SHADOW LN
LAS VEGAS, NV
89106-4194

Practice Phone: 702-388-8436
Practice Fax:

1750549424 — JEREMY JUHANI KOKKONEN DO
Practice Location Address:

620 SHADOW LANE
LAS VEGAS, NV
89106-4194

Practice Phone: 702-388-4000
Practice Fax: 702-388-8431

1205082997 — FRANK C FARINA D.O.
Practice Location Address:

620 SHADOW LANE , VALLEY HOSPITAL MEDICAL CENTER
LAS VEGAS, NV
89106-4194

Practice Phone: 702-388-8436
Practice Fax: 702-388-8431

1497901185 — JON RADLEY MARTIN D.O.
Practice Location Address:

620 SHADOW LANE , VALLEY HOSPITAL
LAS VEGAS, NV
89106-4194

Practice Phone: 702-388-8436
Practice Fax: 702-388-8431

Directions to “ DYLAN LEE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.