Healthcare Provider Details

I. General information

NPI: 1134692486
Provider Name (Legal Business Name): SEAN H LEE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
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

9950 TOPANGA CANYON BLVD UNIT 79
CHATSWORTH CA
91311-3665
US

V. Phone/Fax

Practice location:
  • Phone: 424-677-2594
  • Fax:
Mailing address:
  • Phone: 818-983-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6130
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0116032141
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP206474
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: