Healthcare Provider Details

I. General information

NPI: 1619197282
Provider Name (Legal Business Name): LEE ORTHOPEDIC INSTITUTE, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S. VERMONT AVE.
LOS ANGELES CA
90006
US

IV. Provider business mailing address

1035 S. VERMONT AVE.
LOS ANGELES CA
90006
US

V. Phone/Fax

Practice location:
  • Phone: 213-387-0102
  • Fax: 213-738-8764
Mailing address:
  • Phone: 213-387-0102
  • Fax: 213-738-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG86203
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG86203
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA67707
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberG86203
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberA67707
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTOPHE S LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-387-0102