Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A61349 | CA |
NPI | 1821029794 |
---|---|
Provider Name | Dr. Nina Lee-Tall |
First Address | Torrance, CA 90510-3098 |
Second Address | Torrance, CA 90503-5804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 03/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63541 | (02) | CA |