Healthcare Provider Details

I. General information

NPI: 1043402118
Provider Name (Legal Business Name): JOSEPH P LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 FOREST AVE SUITE 110
SAN JOSE CA
95128-4833
US

IV. Provider business mailing address

2030 FOREST AVE SUITE 110
SAN JOSE CA
95128-4833
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2929
  • Fax:
Mailing address:
  • Phone: 408-947-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: