Provider Demographics
NPI:1023049590
Name:LEE, EUGENE YOUNG (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:YOUNG
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 1:100 S ELLSWORTH AVE STE 507
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3929
Mailing Address - Country:US
Mailing Address - Phone:650-342-7432
Mailing Address - Fax:650-342-3239
Practice Address - Street 1:100 SOUTH ELLSWORTH AVENUE
Practice Address - Street 2:SUITE 507
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2708
Practice Address - Country:US
Practice Address - Phone:650-342-7432
Practice Address - Fax:650-342-3239
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A872615Medicare ID - Type Unspecified