Provider Demographics
NPI:1699947317
Name:LEE, IVY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E. GREEN STREET
Mailing Address - Street 2:SUITE #330
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106
Mailing Address - Country:US
Mailing Address - Phone:626-449-4207
Mailing Address - Fax:626-449-0925
Practice Address - Street 1:960 E. GREEN STREET
Practice Address - Street 2:SUITE #330
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106
Practice Address - Country:US
Practice Address - Phone:626-449-4207
Practice Address - Fax:626-449-0925
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111232207N00000X
DCMD036840207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology