Provider Demographics
NPI:1083501183
Name:LEE, TIM Y
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:Y
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4458 209TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:EAST BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55011-4101
Mailing Address - Country:US
Mailing Address - Phone:651-270-7089
Mailing Address - Fax:651-270-7089
Practice Address - Street 1:4458 209TH AVE NE
Practice Address - Street 2:
Practice Address - City:EAST BETHEL
Practice Address - State:MN
Practice Address - Zip Code:55011-4101
Practice Address - Country:US
Practice Address - Phone:651-270-7089
Practice Address - Fax:651-270-7089
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver