Provider Demographics
NPI:1326044595
Name:LEE, EDWARD C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4906 EL CAMINO REAL
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1449
Mailing Address - Country:US
Mailing Address - Phone:650-967-1770
Mailing Address - Fax:650-967-1936
Practice Address - Street 1:4906 EL CAMINO REAL
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1449
Practice Address - Country:US
Practice Address - Phone:650-967-1770
Practice Address - Fax:650-967-1936
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2010-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG-084584207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG06999Medicare UPIN