Provider Demographics
NPI:1063536431
Name:LEE, KEVIN TIEN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TIEN
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 1:5801 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1852
Mailing Address - Country:US
Mailing Address - Phone:626-292-1241
Mailing Address - Fax:626-292-1746
Practice Address - Street 1:5801 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-1852
Practice Address - Country:US
Practice Address - Phone:626-292-1241
Practice Address - Fax:626-292-1746
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A993540Medicare PIN