MEDICARE: DR. THOMAS T, 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
1	207V00000X	Obstetrics & Gynecology Physician	A37294	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942304373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS T, LEE M.D.

Provider Business Mailing Address
First Line	:	4950 SAN BERNARDINO ST
Second Line	:	STE #106
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2328
Country	:	US
Telephone Number	:	909-450-5000
Fax Number	:	909-621-6735

Provider Business Practice Location Address
First Line	:	4950 SAN BERNARDINO ST
Second Line	:	STE #106
City	:	MONTCLAIR
State	:	CA
Zip	:	91763-2328
Country	:	US
Telephone Number	:	909-450-5000
Fax Number	:	909-621-6735

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	10/19/2015

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