Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A134450 | CA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | A134450 | CA |
NPI | 1164786042 |
---|---|
Provider Name | Jason F Lee |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Burbank, CA 91505-4044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 24/10/2019 |