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General NPI Number Information
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NPI Number | 1366431348
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Entity Type | Individual
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Provider Name | IVAN Y LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 27001 CALAROGA AVE #5
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City | HAYWARD
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State | CA
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Zip | 94545-4345
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Country | US
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Telephone | 510-783-6444
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Fax | 510-783-6446
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Provider Business Mailing Address
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Address Line | 27001 CALAROGA AVE #5
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City | HAYWARD
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State | CA
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Zip | 94545-4345
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Country | US
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Telephone | 510-783-6444
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Fax | 510-783-6446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G80771
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License Number State | CA
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