Healthcare Provider Details

I. General information

NPI: 1912052275
Provider Name (Legal Business Name): LESLIE LEE, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S RAYMOND AVE
ALHAMBRA CA
91801-3166
US

IV. Provider business mailing address

150 S RAYMOND AVE
ALHAMBRA CA
91801-3166
US

V. Phone/Fax

Practice location:
  • Phone: 626-300-0008
  • Fax:
Mailing address:
  • Phone: 626-300-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA062246
License Number StateCA

VIII. Authorized Official

Name: DR. LESLIE LEE
Title or Position: OWNER
Credential: M.D.
Phone: 626-300-0008