MEDICARE: DR. IRWIN H 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	2085R0001X	Radiation Oncology Physician	4301081665	MI
2	390200000X	Student in an Organized Health Care Education/Training Program	4301081665	MI
3	2085R0001X	Radiation Oncology Physician	A103038	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

General Provider Information

NPI Number	:	1861510760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRWIN H LEE MD

Provider Business Mailing Address
First Line	:	PO BOX 756
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-0756
Country	:	US
Telephone Number	:	209-543-0684
Fax Number	:	209-343-3809

Provider Business Practice Location Address
First Line	:	301 PROFESSIONAL CENTER DR
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2152
Country	:	US
Telephone Number	:	707-584-2200
Fax Number	:	707-584-7582

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/19/2023

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