MEDICARE: MISS SHUANG LEI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A159635	CA

General Provider Information

NPI Number	:	1497274302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHUANG LEI MD

Provider Business Mailing Address
First Line	:	3705 W PICO BLVD # 820
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	818-649-9123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 W PICO BLVD # 820
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	818-649-9123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	07/13/2023

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