Healthcare Provider Details

I. General information

NPI: 1982995650
Provider Name (Legal Business Name): THOMAS DOMIN LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1950 WESTHOLME AVE
LOS ANGELES CA
90025-5933
US

V. Phone/Fax

Practice location:
  • Phone: 858-869-4208
  • Fax:
Mailing address:
  • Phone: 858-869-4208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberS-16-377
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberS-17-427
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA124424
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ZC0008X
TaxonomyClinical Informatics (Pathology) Physician
License NumberS-21-444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: