Provider Demographics
NPI:1942395157
Name:LEE, MATTHEW K (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
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 1:2036 HANSCOM DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4012
Mailing Address - Country:US
Mailing Address - Phone:323-259-5918
Mailing Address - Fax:
Practice Address - Street 1:4650 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7900
Practice Address - Country:US
Practice Address - Phone:323-226-2406
Practice Address - Fax:323-226-3440
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG627182080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG95839Medicare UPIN
WG62718AMedicare ID - Type Unspecified