Healthcare Provider Details

I. General information

NPI: 1043197122
Provider Name (Legal Business Name): BRIAN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD STE D136
SAN JOSE CA
95128-3914
US

IV. Provider business mailing address

1883 AGNEW RD UNIT 207
SANTA CLARA CA
95054-4237
US

V. Phone/Fax

Practice location:
  • Phone: 408-430-3339
  • Fax:
Mailing address:
  • Phone: 818-254-5646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number35261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: