Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | 20A6461 | CA |
NPI | 1699733766 |
---|---|
Provider Name | Dr. Sean Leson |
First Address | Garden Grove, CA 92843-1907 |
Second Address | Garden Grove, CA 92843-1907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 21/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F67337 | (02) | CA |