Healthcare Provider Details

I. General information

NPI: 1386108918
Provider Name (Legal Business Name): MICHELLE LEE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 10/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR STE 400
BEVERLY HILLS CA
90210-4318
US

IV. Provider business mailing address

416 N BEDFORD DR STE 400
BEVERLY HILLS CA
90210-4318
US

V. Phone/Fax

Practice location:
  • Phone: 310-400-6180
  • Fax:
Mailing address:
  • Phone: 310-400-6180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LEE
Title or Position: PLASTIC SURGEON
Credential: MD
Phone: 310-400-6180