Healthcare Provider Details

I. General information

NPI: 1841852365
Provider Name (Legal Business Name): DONALD YOUNGSHIK LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8536 WILSHIRE BLVD STE 102
BEVERLY HILLS CA
90211-3154
US

IV. Provider business mailing address

1068 S LUCERNE BLVD
LOS ANGELES CA
90019-6808
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-7501
  • Fax:
Mailing address:
  • Phone: 607-351-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA182204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: