MEDICARE: MASON LAI LE

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	374700000X	Technician	L9669	CA
2	174400000X	Specialist	L9669	CA

General Provider Information

NPI Number	:	1902498157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASON LAI LE

Provider Business Mailing Address
First Line	:	41 S CHESTER AVE STE A1
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-3104
Country	:	US
Telephone Number	:	626-460-0048
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 E GREEN ST STE 207
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2417
Country	:	US
Telephone Number	:	626-460-0048
Fax Number	:

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	04/27/2022

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Directions to “ MASON LAI LE” Practice Location

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