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General NPI Number Information
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NPI Number | 1053745943
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Entity Type | Individual
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Provider Name | BENJAMIN LEE D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 1401 N 10TH AVE STE 200
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City | STAYTON
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State | OR
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Zip | 97383-1487
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Country | US
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Telephone | 503-769-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 E CESAR E CHAVEZ AVE
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City | LOS ANGELES
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State | CA
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Zip | 90033-2414
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Country | US
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Telephone | 323-268-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | DO187114
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License Number State | OR
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