Healthcare Provider Details

I. General information

NPI: 1932387974
Provider Name (Legal Business Name): MICHAEL J LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 W SUNSET BLVD 6TH FLOOR, ELECTROPHYSIOLOGY DEPARTMENT
LOS ANGELES CA
90027-5822
US

IV. Provider business mailing address

71 ESSEX LN
IRVINE CA
92620-0241
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-5850
  • Fax: 323-783-8974
Mailing address:
  • Phone: 714-838-9995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA87262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: