Provider Demographics
NPI:1598725327
Name:LEE, PANDORA (MD)
Entity Type:Individual
Prefix:
First Name:PANDORA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:1000
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-271-4000
Mailing Address - Fax:510-271-4490
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:1000
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-271-4000
Practice Address - Fax:510-271-4490
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G42985Medicare UPIN
G42985Medicare UPIN