Healthcare Provider Details

I. General information

NPI: 1265010383
Provider Name (Legal Business Name): SEUNG MYUNG LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90033-2414
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD # 932922
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 323-268-5000
  • Fax:
Mailing address:
  • Phone: 949-910-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A24802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: