Provider Demographics
NPI:1255442760
Name:LEE, ANDREW H (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-535-2000
Mailing Address - Fax:916-859-1847
Practice Address - Street 1:3000 Q ST FL 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3333
Practice Address - Fax:916-281-3882
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A93482085N0700X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1616096OtherCIGNA
CA00AX93480Medicaid
CAMCMG465300OtherWESTERN HEALTH ADVANTAGE
CA000810785173OtherPHCS
CA20A9348OtherBLUE CROSS
CA5695122OtherFIRST HEALTH
CA131555OtherHEALTH NET
CA2045388OtherGREAT WEST
CA454799OtherINTERPLAN
CA7282139OtherAETNA
CA90204090OtherPACIFICARE
CA2656695OtherUNITED HEALTHCARE
CA5695122OtherFIRST HEALTH
CAI60317Medicare UPIN