Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | G73560 | CA |
NPI | 1265894927 |
---|---|
Provider Name | Jeffrey Chi Fai Lee |
First Address | Tustin, CA 92780-3031 |
Second Address | Tustin, CA 92780-3031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 22/03/2016 |