Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F305331 | NY |
NPI | 1003117136 |
---|---|
Provider Name | Mr. Calvin Kailun Lee |
First Address | New York, NY 10032-3720 |
Second Address | New York, NY 10032-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2010 |
Last Update Date | 26/04/2018 |