Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 60787 | CA |
Y | 1223P0700X | Prosthodontist | 60787 | CA |
NPI | 1245551951 |
---|---|
Provider Name | Dr. Loren Lee |
First Address | San Francisco, CA 94121-1545 |
Second Address | San Francisco, CA 94121-1545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 06/02/2016 |