Healthcare Provider Details

I. General information

NPI: 1720818651
Provider Name (Legal Business Name): SCOTT I. LEE, MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S CENTRAL AVE STE 102
GLENDALE CA
91204-2562
US

IV. Provider business mailing address

350 N GLENDALE AVE STE B
GLENDALE CA
91206-3323
US

V. Phone/Fax

Practice location:
  • Phone: 818-614-9188
  • Fax:
Mailing address:
  • Phone: 818-614-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 818-614-9188