Healthcare Provider Details

I. General information

NPI: 1396064796
Provider Name (Legal Business Name): DONG HEE LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 SEPULVEDA BLVD STE 690
SHERMAN OAKS CA
91411-2522
US

IV. Provider business mailing address

800 ROSE ST # C225
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 818-900-6480
  • Fax:
Mailing address:
  • Phone: 859-323-6602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC199614
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberTP421
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number52772
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: