Healthcare Provider Details

I. General information

NPI: 1407019177
Provider Name (Legal Business Name): TIM HSIN-AN LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 301
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

111COLCHESTER AVE UVM MEDICAL CENTER, SURGERY/ACUTE CARE
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1854
  • Fax:
Mailing address:
  • Phone: 802-847-3790
  • Fax: 802-847-7853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLL17835
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60916305
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD60916305
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number042.0013451
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: