Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 60785 | CA |
N | 1223X0400X | Orthodontists | WADE6014957 | WA |
NPI | 1033474770 |
---|---|
Provider Name | Kiho Lee |
First Address | Los Angeles, CA 90095-1668 |
Second Address | Los Angeles, CA 90095-1668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 09/07/2012 |