Provider Demographics
NPI:1912004664
Name:LEE, MIMI CECILIA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:CECILIA
Last Name:LEE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PROVIDENCE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1437
Mailing Address - Country:US
Mailing Address - Phone:844-263-9757
Mailing Address - Fax:704-973-0815
Practice Address - Street 1:UCSF DEPARTMENT OF ANESTHESIA
Practice Address - Street 2:505 PARNASSUS AVENUE, SUITE L-08
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0001
Practice Address - Country:US
Practice Address - Phone:415-846-9989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76994207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology