Healthcare Provider Details

I. General information

NPI: 1174552541
Provider Name (Legal Business Name): EDMOND LEE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N GARFIELD AVE STE 305
MONTEREY PARK CA
91754-1242
US

IV. Provider business mailing address

500 N GARFIELD AVE STE 305
MONTEREY PARK CA
91754-1242
US

V. Phone/Fax

Practice location:
  • Phone: 626-703-4188
  • Fax: 213-617-3144
Mailing address:
  • Phone: 626-703-4188
  • Fax: 213-617-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4038
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE4038
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: