Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A112770 | CA |
NPI | 1063723211 |
---|---|
Provider Name | Dr. Dennis Jung-Min Lee |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Carmichael, CA 95608-0302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 01/09/2020 |