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General NPI Number Information
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NPI Number | 1871535971
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Entity Type | Individual
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Provider Name | JAY LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 6041 CADILLAC AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-1702
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Country | US
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Telephone | 323-857-2682
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Fax | 323-857-3915
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Provider Business Mailing Address
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Address Line | 3770 KEYSTONE AVE APT. #208
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City | LOS ANGELES
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State | CA
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Zip | 90034-6360
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Country | US
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Telephone | 323-252-7008
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A83417
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License Number State | CA
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