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NPI Code Detail

MEDICARE: DR. JUSTIN PAUL LEE M.D.

MEDICARE: DR. JUSTIN PAUL LEE M.D.
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
1208M00000XHospitalist PhysicianA119292CA
2207R00000XInternal Medicine PhysicianA119292CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A119292OTHERCASTATE LICENSE

General Provider Information

NPI Number : 1912219650
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN PAUL LEE M.D.
Provider Business Mailing Address
First Line : 3687 MT DIABLO BLVD STE 200
Second Line :
City : LAFAYETTE
State : CA
Zip : 94549-3746
Country : US
Telephone Number : 916-854-6975
Fax Number :
Provider Business Practice Location Address
First Line : 350 HAWTHORNE AVE
Second Line : SUITE #2316
City : OAKLAND
State : CA
Zip : 94609-3108
Country : US
Telephone Number : 510-869-6883
Fax Number : 510-869-6888
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2010
Last Update Date : 07/21/2022

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