Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A60526 | CA |
N | 2080P0205X | Pediatric Endocrinologist | A60526 | CA |
NPI | 1124189717 |
---|---|
Provider Name | Jane Catherine Lee |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 11/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A605260 | MEDI-CAL (01) | CA |
H54072 | (02) | CA |