Provider Demographics
NPI:1972538833
Name:LEE, PING NGA ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:PING NGA ALLAN
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 1:400 EVELYN AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706
Mailing Address - Country:US
Mailing Address - Phone:510-524-4040
Mailing Address - Fax:510-524-4140
Practice Address - Street 1:400 EVELYN AVE
Practice Address - Street 2:STE 107
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706
Practice Address - Country:US
Practice Address - Phone:510-524-4040
Practice Address - Fax:510-524-4140
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240096207R00000X, 207RI0200X
CAC54273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906170Medicaid
VAP00356139OtherRAILROAD MEDICARE
VAP00356139OtherRAILROAD MEDICARE