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General NPI Number Information
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NPI Number | 1215020292
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Entity Type | Organization
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Legal Business Name | NINA J LEE TALL MD INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 1200 S PACIFIC COAST HWY STE C
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4987
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Country | US
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Telephone | 310-375-2102
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Fax | 310-791-6319
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Provider Business Mailing Address
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Address Line | 1200 S PACIFIC COAST HWY STE C
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City | REDONDO BEACH
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State | CA
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Zip | 90277-4987
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Country | US
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Telephone | 310-375-2102
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Fax | 310-791-6319
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Authorized Official
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Title or Position | PRESIDENT
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Name | NINA J LEE-TALL
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Credential | MD
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Telephone | 310-375-2102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | A61349
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License Number State | CA
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