Provider Demographics
NPI:1447343082
Name:LEE, TINA (MD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 5TH AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3132
Mailing Address - Country:US
Mailing Address - Phone:206-374-0109
Mailing Address - Fax:206-374-0108
Practice Address - Street 1:1200 5TH AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3132
Practice Address - Country:US
Practice Address - Phone:206-374-0109
Practice Address - Fax:206-374-0108
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK55802084P0804X
WAMD000402172084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1389Medicaid
AK8EC008Medicare Oscar/Certification
AK8EC011Medicare Oscar/Certification
AK8EC010Medicare Oscar/Certification
AKI41510Medicare UPIN
AK8EC009Medicare Oscar/Certification
AKMD1389Medicaid