Healthcare Provider Details

I. General information

NPI: 1164500898
Provider Name (Legal Business Name): EDWARD R. LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 SUTTER PL STE 1000
DAVIS CA
95616-6215
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 530-750-5904
  • Fax: 530-750-5905
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA80709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: