Healthcare Provider Details

I. General information

NPI: 1124014741
Provider Name (Legal Business Name): MIN-WEI CHRISTINE LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 N WIGET LN STE 125
WALNUT CREEK CA
94598-2546
US

IV. Provider business mailing address

370 N WIGET LN STE 125
WALNUT CREEK CA
94598-2546
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-9389
  • Fax: 925-393-5996
Mailing address:
  • Phone: 925-932-9389
  • Fax: 925-256-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG80164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG80164
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberG80164
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG80164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: