1477500304 NPI number — DR. TAT- SUM LEE M.D.

Table of content: DR. TAT- SUM LEE M.D. (NPI 1477500304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477500304 NPI number — DR. TAT- SUM LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
TAT- SUM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477500304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3898 VINEYARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNKIRK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14048-3559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-363-2233
Provider Business Mailing Address Fax Number:
716-363-2237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3898 VINEYARD DR
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
DUNKIRK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14048-3559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-363-1515
Provider Business Practice Location Address Fax Number:
716-363-7677
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  126308 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6407025 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000507408002 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00600702 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00010102203 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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