Provider Demographics
NPI:1346300274
Name:LEE, ROBERT AN-KUO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:AN-KUO
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-521-7760
Mailing Address - Fax:707-521-7759
Practice Address - Street 1:3883 AIRWAY DR STE 203
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403
Practice Address - Country:US
Practice Address - Phone:707-521-7760
Practice Address - Fax:707-521-7759
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA874491207N00000X, 207ND0900X
CAA109496207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA109496OtherSTATE MEDICAL LICENSE