Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 21017 | TX |
NPI | 1164880456 |
---|---|
Provider Name | Chia-Ming Lee |
First Address | Bedford, TX 76095-0662 |
Second Address | Arlington, TX 76013-2543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2016 |
Last Update Date | 02/02/2016 |