Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 57479 | CA |
Y | 213EG0000X | General Practice | 57479 | CA |
NPI | 1003049826 |
---|---|
Provider Name | Dr. Wade W Lee |
First Address | Sunnyvale, CA 94086-0243 |
Second Address | Sunnyvale, CA 94087-1982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2009 |
Last Update Date | 16/07/2013 |