MEDICARE: ALANE M LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	48945	CA

General Provider Information

NPI Number	:	1669686820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALANE M LEE

Provider Business Mailing Address
First Line	:	1706 WILLOW ST STE A
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5216
Country	:	US
Telephone Number	:	408-265-8365
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 WILLOW ST STE A
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5216
Country	:	US
Telephone Number	:	408-265-8365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	02/12/2008

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