Provider Demographics
NPI: | 1326165366 |
---|---|
Name: | RICHARD D LEE, MD INC. |
Entity Type: | Organization |
Organization Name: | RICHARD D LEE, MD INC. |
Other - Org Name: | HOMETOWN HEALTHCARE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RICHARD |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | LEE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 650-289-0110 |
Mailing Address - Street 1: | 605 COWPER ST |
Mailing Address - Street 2: | |
Mailing Address - City: | PALO ALTO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94301-1808 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 650-289-0110 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 605 COWPER ST |
Practice Address - Street 2: | |
Practice Address - City: | PALO ALTO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94301-1808 |
Practice Address - Country: | US |
Practice Address - Phone: | 650-289-0110 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-23 |
Last Update Date: | 2012-11-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | F01601 | Medicare UPIN |