Bryan X Lee MD a Professional Medical Corporation

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

A91137 Issued in CA

Legal business name

BRYAN X LEE MD A PROFESSIONAL MEDICAL CORPORATION

Doing business as

Southern California Center for Pain Management

Practice address

250 W Bonita Ave
Suite 160
Pomona, CA 91767-1863

Phone

(909) 593-1002

Fax

(888) 257-3888

NPI assigned

Jan 30, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Bryan X Lee, MDNPI 1467512624

Title

President

Phone

(909) 593-1002

Specialties & licenses 3

Addresses

Other names 1

• Southern California Center for Pain Management Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 4

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

• Bryan Xiao-Qiu Lee, MD

  • Interventional Pain Medicine Physician
  • Pomona, CA
  • NPI 1467512624
  Medicare reassignment Care Compare group NPD Authorized official
• Angelique Babette Carter, RN, FNP

  • Family Nurse Practitioner
  • Chino, CA
  • NPI 1003158353
  Medicare reassignment Care Compare group
• Phuong Anh Thi La, P.A.-C

  • Medical Physician Assistant
  • Riverside, CA
  • NPI 1891865747
  NPD (past)
• Jason Haeshik Shin, M. D.

  • Gastroenterology Physician
  • Pomona, CA
  • NPI 1316926678
  NPD (past)

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

{
    "created_epoch": "1296345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676505600000",
    "number": "1144526773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2240",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917882240",
            "telephone_number": "909-593-1002",
            "fax_number": "909-593-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W BONITA AVE",
            "address_2": "SUITE 160",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671863",
            "telephone_number": "909-593-1002",
            "fax_number": "888-257-3888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13768 Roswell Ave Ste 215",
            "address_purpose": "LOCATION",
            "city": "Chino",
            "state": "CA",
            "postal_code": "917101407",
            "country_code": "US",
            "telephone_number": "909-593-1002",
            "fax_number": "888-257-3888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRYAN X LEE MD A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-30",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "X",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-593-1002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A91137",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A96828",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "A91137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern California Center for Pain Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern California Center for Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zoila Angelita Brown
• Sarah Brownen
• Miah Browning
• Sarah Lynn Brubaker, NONE
• Bruce W Barker, MD, Faap, Inc.
• Heather Bryant
• Hannah Bucklin
• Kartika Budiman, NURSE PRACTITIONER
• Adriana Buenaventura
• Socorro Buenaventura, LMFT

• Interventional Pain Medicine Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• Interventional Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2023; 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.