Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 35629 | CA |
NPI | 1124172309 |
---|---|
Provider Name | Dr. Callin K Lee |
First Address | Modesto, CA 95350-1038 |
Second Address | Modesto, CA 95350-1038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 26/12/2013 |