Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A68322 | CA |
NPI | 1326009572 |
---|---|
Provider Name | Dr. Gordon K. Lee |
First Address | Palo Alto, CA 94304-5715 |
Second Address | Palo Alto, CA 94304-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151752-03 | CSHCN (01) | TX |
1591752-03 | (05) | TX |
8M7997 | BLUE SHIELD (01) | TX |
H87874 | (02) | TX |
P00166123 | RR/MEDICARE (01) | TX |