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General NPI Number Information
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NPI Number | 1144526773
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Entity Type | Organization
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Legal Business Name | BRYAN X LEE MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/30/2011
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 250 W BONITA AVE SUITE 160
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City | POMONA
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State | CA
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Zip | 91767-1863
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Country | US
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Telephone | 909-593-1002
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Fax | 888-257-3888
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Provider Business Mailing Address
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Address Line | PO BOX 2240
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City | WALNUT
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State | CA
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Zip | 91788-2240
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Country | US
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Telephone | 909-593-1002
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Fax | 909-593-1004
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN X LEE
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Credential | MD
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Telephone | 909-593-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | A91137
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A96828
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | A91137
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License Number State | CA
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