Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30225 | IA |
NPI | 1083878763 |
---|---|
Provider Name | Dr. Donald Leslie Chi |
First Address | Iowa City, IA 52245-4808 |
Second Address | Iowa City, IA 52245-4808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 11/07/2008 |