Healthcare Provider Details

I. General information

NPI: 1457092470
Provider Name (Legal Business Name): VIVIAN LEI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 DURALEIGH RD STE 111
RALEIGH NC
27612-2688
US

IV. Provider business mailing address

5603 DURALEIGH RD STE 111
RALEIGH NC
27612-2688
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-0840
  • Fax:
Mailing address:
  • Phone: 919-791-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2026-02432
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: