Healthcare Provider Details

I. General information

NPI: 1992019145
Provider Name (Legal Business Name): KIMBERLY J LEE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N CAMDEN DR 780
BEVERLY HILLS CA
90210-4409
US

IV. Provider business mailing address

433 N CAMDEN DR 780
BEVERLY HILLS CA
90210-4409
US

V. Phone/Fax

Practice location:
  • Phone: 310-882-5656
  • Fax:
Mailing address:
  • Phone: 310-882-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA89400
License Number StateCA

VIII. Authorized Official

Name: KIMBERLY J LEE
Title or Position: CEO
Credential: MD
Phone: 310-882-5656