Provider Demographics
NPI:1437336609
Name:LEE, BRYAN (MD, JD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 WARNER CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2351
Mailing Address - Country:US
Mailing Address - Phone:857-928-3657
Mailing Address - Fax:
Practice Address - Street 1:762 ALTOS OAKS DR
Practice Address - Street 2:STE 1
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5434
Practice Address - Country:US
Practice Address - Phone:650-948-9123
Practice Address - Fax:650-948-0563
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136126207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA159176Medicare PIN
WA0297180OtherL&I
WA1437336609Medicaid