Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DDS101152 | CA |
NPI | 1033773700 |
---|---|
Provider Name | Robert John Lee |
First Address | Torrance, CA 90505-3157 |
Second Address | Chino, CA 91710-5402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2019 |
Last Update Date | 27/04/2019 |