Healthcare Provider Details

I. General information

NPI: 1730216565
Provider Name (Legal Business Name): TIMOTHY LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25407 HOPKINS PL
STEVENSON RANCH CA
91381-1424
US

IV. Provider business mailing address

25407 HOPKINS PL
STEVENSON RANCH CA
91381-1424
US

V. Phone/Fax

Practice location:
  • Phone: 213-265-5775
  • Fax:
Mailing address:
  • Phone: 213-265-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA96022
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: