Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | A066221 | CA |
NPI | 1366599607 |
---|---|
Provider Name | Dr. Tzielan Chang Lee |
First Address | Stanford, CA 94305-5208 |
Second Address | Palo Alto, CA 94304-1503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A066221 | STATE LICENSE (01) | CA |
BL6172073 | DEA LICENSE (01) | CA |
H90545 | (02) | CA |