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General NPI Number Information
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NPI Number | 1740586577
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Entity Type | Individual
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Provider Name | YOUNG AE LEE
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Gender | Female
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 3601 BUDDY OWENS AVE SUIT 200
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City | MCALLEN
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State | TX
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Zip | 78504-6446
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Country | US
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Telephone | 646-593-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 S RADISSON APT 1
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City | PHARR
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State | TX
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Zip | 78577-4391
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Country | US
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Telephone | 646-593-1159
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 010440
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 27385
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License Number State | TX
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