Provider Demographics
NPI:1598032765
Name:LEE, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5303
Mailing Address - Country:US
Mailing Address - Phone:916-485-6500
Mailing Address - Fax:916-485-6814
Practice Address - Street 1:3077 FITE CIR STE 6
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1815
Practice Address - Country:US
Practice Address - Phone:916-854-1801
Practice Address - Fax:916-854-2950
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator