Provider Demographics
NPI:1003259284
Name:MIMI C LEE, MD PHD, P.C.
Entity Type:Organization
Organization Name:MIMI C LEE, MD PHD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MDPHD
Authorized Official - Phone:415-846-9989
Mailing Address - Street 1:151 ALICE B. TOKLAS PLACE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-846-9989
Mailing Address - Fax:704-973-0815
Practice Address - Street 1:151 ALICE B TOKLAS PL UNIT 708
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6962
Practice Address - Country:US
Practice Address - Phone:415-846-9989
Practice Address - Fax:704-973-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76994207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty