Healthcare Provider Details

I. General information

NPI: 1780784512
Provider Name (Legal Business Name): LEE R. WALKER MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14830 LOS GATOS BLVD STE 200
LOS GATOS CA
95032-2053
US

IV. Provider business mailing address

14830 LOS GATOS BLVD STE 200
LOS GATOS CA
95032-2053
US

V. Phone/Fax

Practice location:
  • Phone: 408-412-8400
  • Fax: 408-412-5500
Mailing address:
  • Phone: 408-412-8400
  • Fax: 408-427-9666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number38618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: