Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DD3544 | NM |
N | 122300000X | Dentist | DDS60610 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 60610 | CA |
NPI | 1043590482 |
---|---|
Provider Name | Dr. Shaun M. Lee |
First Address | Chico, CA 95926-1628 |
Second Address | Chico, CA 95926-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2011 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | NM |