Individual
MR. PHOMINIK T LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8670 KELWOOD WAY, SAME, SACRAMENTO, CA 95828-3858
(916) 230-8494
Mailing address
8670 KELWOOD WAY, SAME, SACRAMENTO, CA 95828-3858
(916) 230-8494
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
CA
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
CA
347C00000X
Private Vehicle
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99
—
CA
Enumeration date
05/09/2008
Last updated
05/09/2008
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