MEDICARE: SEM LEE

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00305916	OTHER	CA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1891717245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEM LEE

Provider Business Mailing Address
First Line	:	1165 LINCOLN AVE
Second Line	:	STE.300
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3043
Country	:	US
Telephone Number	:	408-287-3785
Fax Number	:	408-287-2701

Provider Business Practice Location Address
First Line	:	1165 LINCOLN AVE
Second Line	:	STE.300
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3043
Country	:	US
Telephone Number	:	408-287-3785
Fax Number	:	408-287-2701

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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Directions to “ SEM LEE ” Practice Location

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