Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D11508 | OR |
NPI | 1043758592 |
---|---|
Provider Name | Dr. Somang Lee |
First Address | Mesa, AZ 85206-6784 |
Second Address | Wood Village, OR 97060-2667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2017 |
Last Update Date | 17/09/2021 |