Healthcare Provider Details

I. General information

NPI: 1316924152
Provider Name (Legal Business Name): CHIEN-YING LEE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CERRILLOS RD DENTAL DEPARTMENT
SANTA FE NM
87505-3554
US

IV. Provider business mailing address

1700 CERRILLOS RD DENTAL DEPARTMENT
SANTA FE NM
87505-3554
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-9485
  • Fax:
Mailing address:
  • Phone: 505-946-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number0401410668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: