Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 37575 | CA |
NPI | 1124249214 |
---|---|
Provider Name | Dr. Edward Stanley Lee |
First Address | San Francisco, CA 94116 |
Second Address | San Francisco, CA 94116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |