Healthcare Provider Details

I. General information

NPI: 1699038620
Provider Name (Legal Business Name): LILY LEE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S SANTA ANITA STREET STE P25
SAN GABRIEL CA
91776-1145
US

IV. Provider business mailing address

301 W HUNTINGTON DR STE 107
ARCADIA CA
91007-3400
US

V. Phone/Fax

Practice location:
  • Phone: 626-676-2373
  • Fax:
Mailing address:
  • Phone: 626-574-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LILY LEE
Title or Position: OWNER
Credential: MD
Phone: 626-676-2373