Healthcare Provider Details

I. General information

NPI: 1386520138
Provider Name (Legal Business Name): SLEE FOOT AND ANKLE, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MALAGA COVE PLZ STE 206A
PALOS VERDES ESTATES CA
90274-6813
US

IV. Provider business mailing address

36 MALAGA COVE PLZ STE 206A
PALOS VERDES ESTATES CA
90274-6813
US

V. Phone/Fax

Practice location:
  • Phone: 424-677-2594
  • Fax: 424-624-7910
Mailing address:
  • Phone: 424-677-2594
  • Fax: 424-624-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEAN H LEE
Title or Position: PRESIDENT
Credential: DPM
Phone: 818-983-8758