Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A055074 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | A055074 | CA |
N | 207NS0135X | Procedural Dermatology | A055074 | CA |
NPI | 1073633467 |
---|---|
Provider Name | Gary Cheukman Lee |
First Address | Irvine, CA 92604-8653 |
Second Address | Irvine, CA 92604-8653 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 19/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G73961 | (02) | CA |