Healthcare Provider Details

I. General information

NPI: 1790619906
Provider Name (Legal Business Name): CS&KT LEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 VALLEY VISTA DR STE 278
DIAMOND BAR CA
91765-3909
US

IV. Provider business mailing address

1370 VALLEY VISTA DR STE 278
DIAMOND BAR CA
91765-3909
US

V. Phone/Fax

Practice location:
  • Phone: 626-682-2779
  • Fax:
Mailing address:
  • Phone: 626-682-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS T LEE
Title or Position: OWNER
Credential: LEE
Phone: 909-896-3911