Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4470 | CA |
Y | 222Z00000X | Podiatrist | E4470 | CA |
NPI | 1023047347 |
---|---|
Provider Name | Dr. Jimmy Lee |
First Address | Arcadia, CA 91007-9256 |
Second Address | Arcadia, CA 91007-9256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4821080001 | NORIDIAN DME SUPP ID# (01) | CA |
P00299462 | PALMETTO GBA (01) | CA |
U95081 | (02) | CA |