MEDICARE: THOMAS C. LEE M.D. INC.

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	207L00000X	Anesthesiology Physician		CA

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
2	00G803283	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1679582993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS C. LEE M.D. INC.

Provider Business Mailing Address
First Line	:	PO BOX 4259
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-4259
Country	:	US
Telephone Number	:	562-407-2080
Fax Number	:	562-407-2082

Provider Business Practice Location Address
First Line	:	18575 GALE AVE
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91748-1340
Country	:	US
Telephone Number	:	626-965-3880
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS CHEN LEE
Credential	:	M.D.
Telephone Number	:	909-837-9097

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	09/23/2024

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