Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | MA |
NPI | 1760536098 |
---|---|
Provider Name | Dr. Samson F Lee |
First Address | San Francisco, CA 94112-3762 |
Second Address | San Francisco, CA 94112-3762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |