Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | A123480 | CA |
Y | 2080P0202X | Pediatric Cardiologist | R7258 | TX |
NPI | 1174815005 |
---|---|
Provider Name | Dr. Jesse Wei-Dirk Lee |
First Address | Los Angeles, CA 90045-5631 |
Second Address | San Antonio, TX 78207-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2011 |
Last Update Date | 02/12/2021 |