Healthcare Provider Details

I. General information

NPI: 1508360421
Provider Name (Legal Business Name): MICHAEL TEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 JOHN ST
SEATTLE WA
98109-5213
US

IV. Provider business mailing address

910 JOHN ST
SEATTLE WA
98109-5213
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-2590
  • Fax: 206-752-1480
Mailing address:
  • Phone: 206-823-2590
  • Fax: 206-752-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number317025
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number317025
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD70023321
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD70023321
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: