Provider Demographics
NPI:1861508335
Name:LEE, DIANE D (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:D
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DI
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 EVELYN AVE STE 224
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706
Mailing Address - Country:US
Mailing Address - Phone:510-526-0888
Mailing Address - Fax:510-526-0886
Practice Address - Street 1:400 EVELYN AVE STE 224
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706
Practice Address - Country:US
Practice Address - Phone:510-526-0888
Practice Address - Fax:510-526-0886
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA786112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH65081Medicare UPIN
CA00A786111Medicare ID - Type Unspecified