Healthcare Provider Details

I. General information

NPI: 1326254137
Provider Name (Legal Business Name): TIMOTHY TIEN-MIN LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 LAUREL ST STE 230
RANCHO CUCAMONGA CA
91730-7659
US

IV. Provider business mailing address

10737 LAUREL ST STE 230
RANCHO CUCAMONGA CA
91730-7659
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-5556
  • Fax: 909-989-5558
Mailing address:
  • Phone: 909-989-5556
  • Fax: 909-989-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA101050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: