Provider Demographics
NPI:1457593238
Name:LEE, FRED THOMAS JUNFEI (MD)
Entity type:Individual
Prefix:
First Name:FRED THOMAS
Middle Name:JUNFEI
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 1:2251 N RAMPART BLVD # 338
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7640
Mailing Address - Country:US
Mailing Address - Phone:702-686-0707
Mailing Address - Fax:702-733-6899
Practice Address - Street 1:4275 BURNHAM AVE STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:702-686-0707
Practice Address - Fax:702-733-6899
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47951208600000X
NV17930208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1457593238Medicaid