Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | A94671 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A94671 | CA |
NPI | 1083775696 |
---|---|
Provider Name | Dr. Susan J Lee |
First Address | Tarzana, CA 91356-3508 |
Second Address | Tarzana, CA 91356-3508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |