| 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 |