Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTD010126667 | OR |
NPI | 1760611958 |
---|---|
Provider Name | Hea Chan Lee |
First Address | Aloha, OR 97007-1567 |
Second Address | Aloha, OR 97007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2009 |
Last Update Date | 10/01/2013 |