Healthcare Provider Details

I. General information

NPI: 1184068496
Provider Name (Legal Business Name): WEN-SHIN LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13624 W CAMINO DEL SOL STE 200
SUN CITY WEST AZ
85375-3401
US

IV. Provider business mailing address

2452 WATSON CT
PALO ALTO CA
94303-3216
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-8400
  • Fax:
Mailing address:
  • Phone: 650-723-6995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA131696
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number74605
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberA131696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: