NPIMap

Organization Active NPI

Phillip H a Lee MD and Center for Advanced Dermatology

  • Preferred Provider Organization
  • Glendale, CA
National Provider Identifier
1124497524
Registry record updated Feb 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
PHILLIP H A LEE MD AND CENTER FOR ADVANCED DERMATOLOGY
Practice address
1510 S Central Ave Ste 470
Glendale, CA 91204-2514
Phone
(818) 242-0035
Fax
(818) 242-3628
NPI assigned
Sep 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Phillip H a Lee, MDNPI 1578628731
Title
President
Phone
(818) 242-0035

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X Primary

Addresses

Primary practice location

1510 S Central Ave Ste 470
Glendale, CA 91204-2514

Mailing address

1510 S Central Ave Ste 470
Glendale, CA 91204-2514
Phone (818) 242-0035

Other names 1

  • GLENDALE LASER AND DERMATOLOGY ASSOCIATES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160218002489 CA Part B Supplier - Clinic/Group Practice 0345545943 Receives reassigned benefits from 8 practitioners
Practice locations: South Pasadena, CA

National Provider Directory

National Provider Directory

Locations

1510 S Central Ave
Ste 470
Glendale, CA 91204
Phone (818) 242-0035

245 Fair Oaks Ave
South Pasadena, CA 91030
Phone (626) 333-7773

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455840000000",
    "number": "1124497524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE STE 470",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042514",
            "telephone_number": "818-242-0035",
            "fax_number": "818-242-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 S CENTRAL AVE STE 470",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042514",
            "telephone_number": "818-242-0035",
            "fax_number": "818-242-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHILLIP H A LEE MD AND CENTER FOR ADVANCED DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-16",
        "last_updated": "2016-02-19",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "H A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-242-0035",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLENDALE LASER AND DERMATOLOGY ASSOCIATES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.