Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A63043 | CA |
Y | 2080P0208X | Pediatric Infectious Diseases | A63043 | CA |
NPI | 1417987033 |
---|---|
Provider Name | Dr. Brian Patrick Lee |
First Address | Oakland, CA 94609-1809 |
Second Address | Oakland, CA 94609-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A630430 | (05) | CA |
A63043 | STATE LICENSE NUMBER (01) | CA |
BL5503025 | DEA NUMBER (01) |