Doctor Name: | DR. TIMOTHY LEE |
NPI Number: | 1730165903 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A72498 |
Business Practice Address: | 8510 Balboa Blvd Sutie 150 Northridge, CA - 913253583 |
Business Phone Number: | 8185526230 |
Business Fax Number: | |
Mailing Address: | 8510 Balboa Blvd, Sutie 150 NORTHRIDGE |
State: | CA |
Postal Code: | 913253583 |
Phone Number: | 8185526230 |
Fax Number: | |
NPI Enumeration Date: | 12/20/2005 |
NPI Last Update Date: | 04/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A72498 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |