Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 63214 | CA |
NPI | 1063823524 |
---|---|
Provider Name | Dr. Karis Lee |
First Address | Piedmont, CA 94610-1048 |
Second Address | Piedmont, CA 94610-1048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2014 |
Last Update Date | 04/01/2016 |