MEDICARE: DR. TINA LEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	M4275	TX
2	207Q00000X	Family Medicine Physician	MD443886	PA
3	207Q00000X	Family Medicine Physician	MD61059119	WA
4	208M00000X	Hospitalist Physician	MD61059119	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609864545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 25608
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84125-0608
Country	:	US
Telephone Number	:	206-320-4476
Fax Number	:	206-568-7043

Provider Business Practice Location Address
First Line	:	747 BROADWAY
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4379
Country	:	US
Telephone Number	:	206-215-2520
Fax Number	:	206-386-3180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	04/22/2024

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