Healthcare Provider Details

I. General information

NPI: 1518893718
Provider Name (Legal Business Name): ANGEL LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 THE ALAMEDA # 630
SAN JOSE CA
95126-1404
US

IV. Provider business mailing address

1900 THE ALAMEDA # 630
SAN JOSE CA
95126-1404
US

V. Phone/Fax

Practice location:
  • Phone: 408-475-1665
  • Fax:
Mailing address:
  • Phone: 408-475-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: