=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326188962
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEALAILANI LEE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 EDGEWOOD CT
-----------------------------------------------------
City | DALY CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94014-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-994-7110
-----------------------------------------------------
Fax | 650-994-7180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 WALKER DR APT. #5
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94043-3679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-744-1776
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 00148919
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------