Provider Demographics
NPI:1316044191
Name:LEE, THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 BAY HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1765
Mailing Address - Country:US
Mailing Address - Phone:650-703-3878
Mailing Address - Fax:
Practice Address - Street 1:373 9TH ST
Practice Address - Street 2:STE 307
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6516
Practice Address - Country:US
Practice Address - Phone:510-444-0700
Practice Address - Fax:510-839-4389
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4023213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E40231Medicaid
CA000E40233Medicare ID - Type Unspecified
CA000E40231Medicaid