Provider Demographics
NPI:1710069422
Name:LEE, MAI HUONG (MD)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:HUONG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:HUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8300 ALCOTT ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-4008
Mailing Address - Country:US
Mailing Address - Phone:303-428-0533
Mailing Address - Fax:303-428-2544
Practice Address - Street 1:8300 ALCOTT ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-4008
Practice Address - Country:US
Practice Address - Phone:303-428-0533
Practice Address - Fax:303-428-2544
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710069422OtherNPI
841365302047OtherRKY MTN HMO PROVIDER NUMBER
841365302DYOtherPACIFICARE PROVIDER NUMBER
CO01369941Medicaid
COC103008Medicare UPIN
CO01369941Medicaid
COG95878Medicare UPIN