Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 20A5236 | CA |
NPI | 1275640575 |
---|---|
Provider Name | Dr. Donald Tan-Fog Lee |
First Address | Newark, CA 94560-5367 |
Second Address | Newark, CA 94560-5367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E71387 | (02) | CA |