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General NPI Number Information
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NPI Number | 1992989743
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Entity Type | Organization
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Legal Business Name | PETER LEE
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 15814 WINCHESTER BLVD #101
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City | LOS GATOS
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State | CA
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Zip | 95030-3333
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Country | US
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Telephone | 408-399-3920
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Fax | 408-399-3918
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Provider Business Mailing Address
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Address Line | 1095 BRANHAM LN #101
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City | SAN JOSE
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State | CA
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Zip | 95136-1644
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Country | US
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Telephone | 408-978-8888
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | PETER K LEE
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Credential | DDS
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Telephone | 408-978-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 47749
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License Number State | CA
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