Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401410668 | VA |
NPI | 1316924152 |
---|---|
Provider Name | Chien-Ying Lee |
First Address | Santa Fe, NM 87505-3554 |
Second Address | Santa Fe, NM 87505-3554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 13/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01053779 | (05) | NM |