Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 041719 | NY |
NPI | 1003097601 |
---|---|
Provider Name | Dr. Lydia L Chen |
First Address | Plainview, NY 11803-3312 |
Second Address | Plainview, NY 11803-3312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2007 |
Last Update Date | 25/11/2007 |