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General NPI Number Information
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NPI Number | 1205247376
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Entity Type | Organization
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Legal Business Name | JAI H LEE MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 05/12/2014
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Provider Practice Location Address
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Address Line | 520 S VIRGIL AVE SUITE 103
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City | LOS ANGELES
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State | CA
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Zip | 90020-1416
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Country | US
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Telephone | 213-380-0028
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Fax | 213-380-0036
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Provider Business Mailing Address
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Address Line | 520 S VIRGIL AVE SUITE 103
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City | LOS ANGELES
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State | CA
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Zip | 90020-1416
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Country | US
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Telephone | 213-380-0028
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Fax | 213-380-0036
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAI H LEE
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Credential | M.D.
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Telephone | 213-380-0028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A38492
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License Number State | CA
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