Provider Demographics
NPI:1487140869
Name:JUSTIN THIEN LEE, MD INC
Entity type:Organization
Organization Name:JUSTIN THIEN LEE, MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:THIEN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-356-6998
Mailing Address - Street 1:14182 S CANYON VINE CV
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5636
Mailing Address - Country:US
Mailing Address - Phone:573-356-6998
Mailing Address - Fax:
Practice Address - Street 1:500 OLD RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9505
Practice Address - Country:US
Practice Address - Phone:661-663-6429
Practice Address - Fax:661-663-6041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95245261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty