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General NPI Number Information
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NPI Number | 1619570017
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Entity Type | Organization
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Legal Business Name | MICHAEL C LEE INC
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 2230 LYNN RD STE 320
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1973
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Country | US
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Telephone | 850-449-1600
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Fax | 818-715-1721
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Provider Business Mailing Address
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Address Line | PO BOX 7001
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City | TARZANA
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State | CA
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Zip | 91357-7001
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Country | US
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Telephone | 818-888-7815
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Fax | 818-715-1721
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL C LEE
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Credential | MD
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Telephone | 312-307-9465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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