Provider Demographics
NPI:1144525007
Name:LEE, THOMAS
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9618 GARDEN GROVE BLVD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1563
Mailing Address - Country:US
Mailing Address - Phone:714-539-6562
Mailing Address - Fax:714-539-9077
Practice Address - Street 1:9618 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 221
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1563
Practice Address - Country:US
Practice Address - Phone:714-539-6562
Practice Address - Fax:714-539-9077
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist