Provider Demographics
NPI:1588746754
Name:LEE, DANIEL KEONG (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KEONG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3125
Mailing Address - Country:US
Mailing Address - Phone:510-763-0263
Mailing Address - Fax:510-763-4030
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 1105
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3125
Practice Address - Country:US
Practice Address - Phone:510-763-0263
Practice Address - Fax:510-763-4030
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC276812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC276810Medicaid
A33437Medicare UPIN
CAOOC276810Medicare ID - Type Unspecified