Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 15259 | MD |
NPI | 1003259631 |
---|---|
Provider Name | Dr. Jim Ming-An Lee |
First Address | Hagerstown, MD 21742-4055 |
Second Address | Frederick, MD 21704-5124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2013 |
Last Update Date | 13/04/2013 |