Provider Demographics
NPI:1891709614
Name:SIMON LEE, MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SIMON LEE, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:KWANMIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-692-1388
Mailing Address - Street 1:1828 EL CAMINO REAL
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3103
Mailing Address - Country:US
Mailing Address - Phone:650-692-1388
Mailing Address - Fax:650-692-1380
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:SUITE 406
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3103
Practice Address - Country:US
Practice Address - Phone:650-692-1388
Practice Address - Fax:650-692-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G831691Medicaid
CA00G831691Medicare ID - Type Unspecified
CA00G831691Medicaid