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General NPI Number Information
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NPI Number | 1740437375
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Entity Type | Individual
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Provider Name | TAE YOUNG LEE M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 4234 RIVERWALK PKWY
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City | RIVERSIDE
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State | CA
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Zip | 92505-8510
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Country | US
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Telephone | 518-262-5374
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Fax |
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Provider Business Mailing Address
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Address Line | 4234 RIVERWALK PKWY STE 230
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City | RIVERSIDE
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State | CA
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Zip | 92505-3312
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Country | US
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Telephone | 951-781-3672
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | C165290
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | C165290
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | C165290
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License Number State | CA
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