Provider Demographics
NPI:1710287610
Name:LEE, DIANA YING
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:YING
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 1:2222 BANCROFT WAY RM 1115
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-1201
Mailing Address - Country:US
Mailing Address - Phone:510-642-3249
Mailing Address - Fax:510-642-5759
Practice Address - Street 1:2222 BANCROFT WAY RM 1115
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-1201
Practice Address - Country:US
Practice Address - Phone:510-642-3249
Practice Address - Fax:510-642-5759
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist