Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 0101265554 | VA |
N | 207RI0011X | Interventional Cardiology | 0101265554 | VA |
N | 2080A0000X | Adolescent Medicine | 0101265554 | VA |
N | 2080P0202X | Pediatric Cardiologist | 0101265554 | VA |
Y | 2080P0202X | Pediatric Cardiologist | C170504 | CA |
NPI | 1417426248 |
---|---|
Provider Name | Dr. Kyong-Jin Lee |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2018 |
Last Update Date | 04/01/2021 |