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General NPI Number Information
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NPI Number | 1295296598
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Entity Type | Individual
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Provider Name | BRIAN KISUB LEE DC
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Gender | Male
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 3948 WILSHIRE BLVD # 200
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City | LOS ANGELES
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State | CA
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Zip | 90010-3303
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Country | US
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Telephone | 323-289-8601
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Fax | 323-289-8603
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Provider Business Mailing Address
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Address Line | 835 S LUCERNE BLVD APT 112
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City | LOS ANGELES
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State | CA
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Zip | 90005-3783
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Country | US
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Telephone | 213-210-8763
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 33875
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License Number State | CA
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