Provider Demographics
NPI:1891717245
Name:LEE, SEM
Entity Type:Individual
Prefix:
First Name:SEM
Middle Name:
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 1:1165 LINCOLN AVE
Mailing Address - Street 2:STE.300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3043
Mailing Address - Country:US
Mailing Address - Phone:408-287-3785
Mailing Address - Fax:408-287-2701
Practice Address - Street 1:1165 LINCOLN AVE
Practice Address - Street 2:STE.300
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3043
Practice Address - Country:US
Practice Address - Phone:408-287-3785
Practice Address - Fax:408-287-2701
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00305916OtherRAILROAD MEDICARE
CAC60208Medicare UPIN
CAP00305916OtherRAILROAD MEDICARE