Provider Demographics
NPI:1962548008
Name:LEE, UI SIK (MD)
Entity type:Individual
Prefix:
First Name:UI SIK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 FOREST AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4810
Mailing Address - Country:US
Mailing Address - Phone:408-297-2910
Mailing Address - Fax:408-297-2911
Practice Address - Street 1:2040 FOREST AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4810
Practice Address - Country:US
Practice Address - Phone:408-297-2910
Practice Address - Fax:408-297-2911
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA42461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A424610OtherBLUE SHIELD PROVIDER NUMB