Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A33688 | CA |
NPI | 1003847583 |
---|---|
Provider Name | Mr. Jow Shone Lee |
First Address | Banning, CA 92220-4443 |
Second Address | Banning, CA 92220-4443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A336880 | (05) | CA |