Provider Demographics
NPI:1760790349
Name:LEE, SCOTT I (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:I
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:350 N GLENDALE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3323
Mailing Address - Country:US
Mailing Address - Phone:818-614-9188
Mailing Address - Fax:
Practice Address - Street 1:1500 S CENTRAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2562
Practice Address - Country:US
Practice Address - Phone:818-614-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121741207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine