Individual
JIVIANNE KRISTINE TAN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1131 WILSHIRE BLVD STE 302, SANTA MONICA, CA 90401-2061
(424) 259-6559
(310) 319-3877
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
A72248
CA
Other
Enumeration date
01/08/2007
Last updated
12/04/2019
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