Individual
LARISSE K LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4955 VAN NUYS BLVD, SUITE 704, SHERMAN OAKS, CA 91403
(818) 325-0400
(818) 325-0404
Mailing address
4955 VAN NUYS BLVD, SUITE 704, SHERMAN OAKS, CA 91403
(818) 325-0400
(818) 325-0404
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
239830
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A117214
MEDICAL BOARD STATE LICENSE
CA
Enumeration date
07/14/2008
Last updated
12/02/2019
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