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General NPI Number Information
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NPI Number | 1669527289
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Entity Type | Individual
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Provider Name | DR. JACKSON LEE
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 1520 SAN PABLO ST 2000
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City | LOS ANGELES
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State | CA
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Zip | 90033-5310
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Country | US
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Telephone | 323-442-5860
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 N STATE ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1029
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Country | US
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Telephone | 323-226-2170
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Fax | 323-226-5760
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | G62123
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G62123
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License Number State | CA
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