Provider Demographics
NPI:1659497535
Name:LEE, ALAN IRVING (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:IRVING
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9270
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-2470
Mailing Address - Country:US
Mailing Address - Phone:951-779-1670
Mailing Address - Fax:951-779-1679
Practice Address - Street 1:1906 COMMERCENTER E STE 101
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3423
Practice Address - Country:US
Practice Address - Phone:909-891-1913
Practice Address - Fax:909-884-0810
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105008208000000X
NVLL1581390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105008OtherMEDICAL LICENSE
NVASO2532199136OtherDEA CERTIFICATE
NVLL1581OtherMEDICAL LICENSE
CAFL1087988OtherDEA