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General NPI Number Information
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NPI Number | 1164729398
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Entity Type | Organization
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Legal Business Name | DAVID T LEE MD INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 406 SE 131ST AVE SUITE 109
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City | VANCOUVER
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State | WA
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Zip | 98683-4004
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Country | US
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Telephone | 360-828-1378
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Fax | 360-834-1994
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Provider Business Mailing Address
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Address Line | PO BOX 87784
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City | VANCOUVER
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State | WA
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Zip | 98687-7784
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Country | US
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Telephone | 360-828-1378
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Fax | 360-834-1994
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Authorized Official
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Title or Position | CEO
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Name | DR. DAVID TECHANG LEE
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Credential | M.D.
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Telephone | 360-281-0970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | WA00034070
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License Number State | WA
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