Provider Demographics
NPI:1386264729
Name:LEE, DUSTIN (MD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
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 1:925 SENECA ST
Mailing Address - Street 2:MAIL STOP: H8-GME
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-583-6079
Mailing Address - Fax:
Practice Address - Street 1:2671 NE 46TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5041
Practice Address - Country:US
Practice Address - Phone:206-525-8000
Practice Address - Fax:206-525-8070
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
WAMD61543602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program