Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN1856386 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 253936 | MA |
NPI | 1487988689 |
---|---|
Provider Name | Dr. Wing Cheong Lee |
First Address | North Andover, MA 01845-5042 |
Second Address | North Andover, MA 01845-5042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2009 |
Last Update Date | 15/04/2014 |