Healthcare Provider Details

I. General information

NPI: 1053565143
Provider Name (Legal Business Name): LEE ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2008
Last Update Date: 11/10/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST STE 2000
LOS ANGELES CA
90033-5322
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5860
  • Fax:
Mailing address:
  • Phone: 323-442-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA109863
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA109863
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: