NPI | 1619227352 |
---|---|
Former Name | CHONG CHAN LEE |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA 61057) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS039221) |
Enumeration Date | 2012-09-10 |
Last Update Date | 2017-10-04 |