=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215272380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHUN-TEH LEE DDS,MD,DMSC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2012
-----------------------------------------------------
Last Update Date | 04/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7500 CAMBRIDGE ST SUITE 6470
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-486-4049
-----------------------------------------------------
Fax | 713-486-4393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7500 CAMBRIDGE ST SUITE 6470
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-486-4049
-----------------------------------------------------
Fax | 713-486-4393
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | DL11769
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 28664
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------