Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 42610 | KY |
NPI | 1306813852 |
---|---|
Provider Name | Mrs. Lesley Wong |
First Address | Lexington, KY 40536-0284 |
Second Address | Lexington, KY 40536-0284 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2006 |
Last Update Date | 30/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D72192 | (02) |