Healthcare Provider Details

I. General information

NPI: 1316115579
Provider Name (Legal Business Name): HARRISON H LEE MD, DMD, FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HEEYOUNG LEE MD, DMD, FACS

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 350
BEVERLY HILLS CA
90212-1841
US

IV. Provider business mailing address

120 S SPALDING DR STE 350
BEVERLY HILLS CA
90212-1841
US

V. Phone/Fax

Practice location:
  • Phone: 310-777-2627
  • Fax: 310-777-2632
Mailing address:
  • Phone: 310-777-2627
  • Fax: 310-777-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberG083622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: