Healthcare Provider Details

I. General information

NPI: 1740578483
Provider Name (Legal Business Name): IAN C LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 S FAIR OAKS AVE STE 227
PASADENA CA
91105-2688
US

IV. Provider business mailing address

5767 W CENTURY BLVD # 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 626-639-2902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC202442
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: