=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225521677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEI HO CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2018
-----------------------------------------------------
Last Update Date | 06/11/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1071 W ROUND GROVE RD STE 800
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-7924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-459-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1071 W ROUND GROVE RD STE 800
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-7924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-459-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PATRICK FOOK SANG LAM
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 972-900-6831
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 28247
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------