Provider Demographics
NPI:1205458635
Name:LEE, LINDA (DO)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15913 AVENIDA VILLAHA UNIT 44
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3505
Mailing Address - Country:US
Mailing Address - Phone:858-774-6540
Mailing Address - Fax:
Practice Address - Street 1:11913 NE 195TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3147
Practice Address - Country:US
Practice Address - Phone:425-489-3100
Practice Address - Fax:877-516-8649
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAOP61414364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program