Provider Demographics
NPI:1912999558
Name:LEE, LINDA H (MD PHD MPH)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:MD PHD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 C STREET
Mailing Address - Street 2:SUITE 1300-1400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-734-6111
Mailing Address - Fax:
Practice Address - Street 1:1620 E ROSEVILLE PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-783-7109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48384207N00000X
CA184054207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1912999558Medicaid
WI1912999558Medicaid
WI68086 0455Medicare PIN
NCH63646Medicare UPIN
NC2002293Medicare ID - Type UnspecifiedGRP NO. WITH DUKE PDC