Healthcare Provider Details

I. General information

NPI: 1871292011
Provider Name (Legal Business Name): DAVID LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 TIVERTON DRIVE
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

888 TIVERTON DRIVE
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-6373
  • Fax:
Mailing address:
  • Phone: 310-825-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA199490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: