Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 46859 | CA |
NPI | 1003952391 |
---|---|
Provider Name | Dr. Richard Lee |
First Address | Downey, CA 90242 |
Second Address | Downey, CA 90242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/09/2008 |