Provider Demographics
NPI:1508833377
Name:LEE, KENDRICK E (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:E
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PORTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1587
Mailing Address - Country:US
Mailing Address - Phone:925-838-1440
Mailing Address - Fax:
Practice Address - Street 1:3315 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5717
Practice Address - Country:US
Practice Address - Phone:510-486-2300
Practice Address - Fax:510-486-2333
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62668207XS0106X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G626680Medicaid
CA200018919OtherRAIL ROAD MEDICARE
CA00G626680OtherBLUE SHIELD
CA00G626680OtherBLUE SHIELD
CA00G626682Medicare PIN