Healthcare Provider Details

I. General information

NPI: 1922688720
Provider Name (Legal Business Name): DIONA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 WOODSIDE PLZ
REDWOOD CITY CA
94061-3259
US

IV. Provider business mailing address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

V. Phone/Fax

Practice location:
  • Phone: 650-368-7008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95163429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: