Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 50 053083 | NY |
Y | 213EG0000X | General Practice | 50 053083 | NY |
NPI | 1003031402 |
---|---|
Provider Name | David Formosan Lee |
First Address | Louisville, TN 37777 |
Second Address | New York, NY 10016-1247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 08/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02907899 | (05) | NY |