Healthcare Provider Details

I. General information

NPI: 1063536431
Provider Name (Legal Business Name): KEVIN TIEN LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 W HUNTINGTON DR
ARCADIA CA
91007-6634
US

IV. Provider business mailing address

813 W HUNTINGTON DR
ARCADIA CA
91007-6634
US

V. Phone/Fax

Practice location:
  • Phone: 626-292-1241
  • Fax: 626-292-1746
Mailing address:
  • Phone: 626-292-1241
  • Fax: 626-292-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA99354
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: