Basic Information
| Provider Information | |||||||||
| NPI: | 1073619607 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | PERRY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 COLBY ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947052083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106660854 | ||||||||
| FaxNumber: | 5106661192 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 HAWTHORNE AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106554000 | ||||||||
| FaxNumber: | 5108698906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 09/05/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A71117 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A711170 | 05 | CA | MEDICAID |