Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4038 | CA |
Y | 222Z00000X | Podiatrist | E4038 | CA |
N | 213EP1101X | Primary Podiatric Medicine | E4038 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E4038 | CA |
NPI | 1174552541 |
---|---|
Provider Name | Dr. Edmond Lee |
First Address | Monterey Park, CA 91754-1242 |
Second Address | Monterey Park, CA 91754-1242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 17/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E40380 | (05) | CA |
P00098261 | PALMETTO GBA (01) | |
U65842 | (02) | CA |