MEDICARE: DR. BRYAN LEE MD, JD

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	207W00000X	Ophthalmology Physician	136126	CA

General Provider Information

NPI Number	:	1437336609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN LEE MD, JD

Provider Business Mailing Address
First Line	:	831 WARNER CT
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-2351
Country	:	US
Telephone Number	:	857-928-3657
Fax Number	:

Provider Business Practice Location Address
First Line	:	762 ALTOS OAKS DR
Second Line	:	STE 1
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-5434
Country	:	US
Telephone Number	:	650-948-9123
Fax Number	:	650-948-0563

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

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	12/16/2015

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