Provider Demographics
NPI:1376564393
Name:MAX M. LEE, M.D.
Entity Type:Organization
Organization Name:MAX M. LEE, M.D.
Other - Org Name:MAX LEE, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-824-2183
Mailing Address - Street 1:19711 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2401
Mailing Address - Country:US
Mailing Address - Phone:206-592-5000
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:19711 1ST AVE S
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2401
Practice Address - Country:US
Practice Address - Phone:206-824-2183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1592708Medicaid
WA760111256OtherRR MEDICARE
WA1592708Medicaid
WA000103010Medicare PIN