Provider Demographics
NPI:1790772861
Name:LEE, EDMOND (MD)
Entity Type:Individual
Prefix:MR
First Name:EDMOND
Middle Name:
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 1:500 UNIVERSITY AVE.
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6524
Mailing Address - Country:US
Mailing Address - Phone:916-830-2000
Mailing Address - Fax:916-830-2001
Practice Address - Street 1:500 UNIVERSITY AVE.
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6524
Practice Address - Country:US
Practice Address - Phone:916-830-2000
Practice Address - Fax:916-830-2001
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47887207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G478870Medicaid
CAA50848Medicare UPIN
CA00G478870Medicaid
0DCH401ZMedicare PIN