Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 53083 | CA |
Y | 213EG0000X | General Practice | 53083 | CA |
NPI | 1003820895 |
---|---|
Provider Name | Dr. Edward Lew |
First Address | San Gabriel, CA 91775-1461 |
Second Address | Los Angeles, CA 90012-2343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |