Provider Demographics
NPI:1982995650
Name:LEE, THOMAS DOMIN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DOMIN
Last Name:LEE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 WESTHOLME AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5933
Mailing Address - Country:US
Mailing Address - Phone:858-869-4208
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:858-869-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAS-21-444207ZC0008X
CAS-16-377207ZH0000X
CAS-17-427207ZP0007X
CA15-284207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0008XAllopathic & Osteopathic PhysiciansPathologyClinical Informatics
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology