Provider Demographics
NPI:1801990270
Name:LEE, DANIEL D (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
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 1:1035 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2710
Mailing Address - Country:US
Mailing Address - Phone:213-387-0102
Mailing Address - Fax:213-738-8764
Practice Address - Street 1:1035 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2710
Practice Address - Country:US
Practice Address - Phone:213-387-0102
Practice Address - Fax:213-738-8764
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67707207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH00570Medicare UPIN
CAA67707Medicare ID - Type Unspecified