Provider Demographics
NPI:1275640575
Name:LEE, DONALD TAN-FOG (DO)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:TAN-FOG
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5886 MOWRY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5367
Mailing Address - Country:US
Mailing Address - Phone:510-226-8832
Mailing Address - Fax:510-226-8958
Practice Address - Street 1:5886 MOWRY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5367
Practice Address - Country:US
Practice Address - Phone:510-226-8832
Practice Address - Fax:510-226-8958
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5236207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX52361Medicare ID - Type Unspecified
CAE71387Medicare UPIN