Healthcare Provider Details

I. General information

NPI: 1073724712
Provider Name (Legal Business Name): PATRICIA W LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SAMARITAN DR #1
SAN JOSE CA
95124-3912
US

IV. Provider business mailing address

2450 SAMARITAN DR STE 1
SAN JOSE CA
95124-3912
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1855
  • Fax: 408-356-4183
Mailing address:
  • Phone: 408-358-1855
  • Fax: 408-356-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD33189
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number61138838
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0066631
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA102563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: