MEDICARE: EDWARD C LEE MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	G084584	CA

General Provider Information

NPI Number	:	1710208475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD C LEE MD INC

Provider Business Mailing Address
First Line	:	4906 EL CAMINO REAL
Second Line	:	SUITE A
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1449
Country	:	US
Telephone Number	:	650-967-1770
Fax Number	:	650-967-1936

Provider Business Practice Location Address
First Line	:	4906 EL CAMINO REAL
Second Line	:	SUITE A
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1449
Country	:	US
Telephone Number	:	650-967-1770
Fax Number	:	650-967-1936

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	EDWARD C LEE
Credential	:	M.D.
Telephone Number	:	650-967-1770

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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Directions to “EDWARD C LEE MD INC ” Practice Location

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