Healthcare Provider Details

I. General information

NPI: 1598988057
Provider Name (Legal Business Name): ARNOLD LEE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5971 VENICE BLVD 4TH FLOOR
LOS ANGELES CA
90034-1713
US

IV. Provider business mailing address

5971 VENICE BLVD 4TH FLOOR
LOS ANGELES CA
90034-1713
US

V. Phone/Fax

Practice location:
  • Phone: 646-270-1632
  • Fax:
Mailing address:
  • Phone: 646-270-1632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA114106
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA114106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: