=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235293671
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANLU LEE DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12845 NE 85TH ST
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033-8009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-828-9721
-----------------------------------------------------
Fax | 425-828-9730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12845 NE 85TH ST
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033-8009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-828-9721
-----------------------------------------------------
Fax | 425-828-9730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE9056
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------