Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A81296 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A81296 | CA |
N | 207ND0900X | Dermatopathologist | A81296 | CA |
N | 207NP0225X | Pediatric Dermatologist | A81296 | CA |
N | 207NS0135X | Procedural Dermatology | A81296 | CA |
NPI | 1235252289 |
---|---|
Provider Name | Dr. Sandra Siew Pin Lee |
First Address | Upland, CA 91786-4906 |
Second Address | Upland, CA 91786-4906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H88217 | (02) | CA |